Factors affecting caloric goal in intensive care patients with intestinal insufficiency or failure. Systematic review.
DOI:
https://doi.org/10.12873/414trejosgallegoKeywords:
intestinal dysfunction; intestinal failure; intestinal failure; caloric goal; nutritional support; critical care.Abstract
Introduction: Insufficiency and intestinal failure are part of gastrointestinal dysfunction and the occurrence of some of these situations is frequent in about 60% of patients hospitalized in intensive care, which affects the fulfillment of nutritional goals. Objective: To establish the factors that affect the fulfillment of the caloric goal of nutritional support in intensive care patients with intestinal insufficiency or failure. Methods: The MEDLINE, SCOPUS and COCHRANE databases were consulted, from January 2015 to September 2020, on caloric goal and intestinal insufficiency and failure in critically ill patients. Two investigators conducted the search, applied the selection criteria, extracted the data, and assessed the methodological quality of the studies. A comparison matrix was made for the articles found and its validity was evaluated. Results: The articles evaluated included critical patients, but with different gastrointestinal disorders according to the cut-off points used in each one. The determinants identified as factors that affect caloric goal were: gastric intolerance, post-pyloric nutrition, use of opioids, use of prokinetics, diarrhea, and multidisciplinary team. No unified parameters were found to measure caloric goal and intestinal insufficiency or failure in most of the studies. Discussion: The articles evaluated were heterogeneous and included critical patients with different gastrointestinal disorders. The determinants identified as factors that affect caloric goal were: gastric intolerance, post-pyloric nutrition, use of opioids, use of prokinetics, diarrhea, and multidisciplinary team. Conclusions: This review highlights the absence of validated parameters to qualify intestinal insufficiency or failure in critically ill patients. The six identified aspects that affect the fulfillment of the caloric goal should be evaluated prospectively in this population.
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