Evaluación de un sistema experto para el soporte nutricional enteral en pacientes críticos con disfunción gastrointestinal
DOI:
https://doi.org/10.12873/421trejos-gallegoPalavras-chave:
tecnologías biomédicas; insuficiencia intestinal; falla intestinal; aplicaciones móviles; cuidado crítico.Resumo
Histórico: A medicina e a nutrição têm usado ferramentas de computador para apoiar a tomada de decisões que melhora o atendimento ao paciente. Um sistema especialista é uma dessas ferramentas que podem orientar os usuários no tratamento de um problema específico. A adesão às diretrizes da prática clínica para o manejo nutricional de pacientes com disfunção gastrointestinal otimiza o tratamento médico e nutricional de pacientes críticos, possibilitando sua recuperação. A utilização de um sistema especialista que facilite essa adesão pode melhorar a evolução clínica dos pacientes.
Objetivo: Avaliar se um sistema especialista desenvolvido como ferramenta para melhorar a adesão dos médicos às diretrizes internacionais e para apoiar a tomada de decisão melhora o manejo do suporte nutricional em pacientes com disfunção gastrointestinal.
Métodos: Entre junho de 2020 e janeiro de 2021, foram coletadas informações médicas de pacientes gravemente enfermos com disfunção gastrointestinal no Hospital Santa Sofia de Caldas. O estudo consistiu em dois tratamentos experimentais, um de pacientes tratados com o auxílio do sistema especialista e outro de pacientes tratados sem o auxílio do sistema especialista, considerados como Grupo Controle. Os dados foram coletados durante os primeiros quatro meses do estudo, sem o auxílio do sistema especialista, e nos quatro meses subsequentes, o cuidado nutricional foi apoiado com a utilização do sistema especialista.
Resultados: Houve diferença estatisticamente significativa (p = 0,0001) entre os tratamentos nas variáveis meta calórica e proteica e início da nutrição enteral. Os pacientes atendidos com auxílio do sistema especialista apresentaram maior adesão às metas calóricas e protéicas e menor tempo de início da nutrição enteral.
Conclusões: a utilização do sistema especialista está associada à melhor adesão às recomendações das diretrizes internacionais, melhorando a tolerância e a oferta de suporte nutricional enteral.
Referências
- Reintam Blaser A, Poeze M, Malbrain ML, Björck M, Oudemans-van StraatenHM, Starkopf J, Gastro-Intestinal Failure Trial Group. Gastrointestinalsymptoms during the first week of intensive care are associated with pooroutcome: a prospective multicentre study. Intensive Care Med. 2013; 39:899–909. doi: 10.1007/s00134-013-2831-1.
- Singer P, Pichard C, Heidegger CP, Wernerman J. Considering energydeficit in the intensive care unit. Curr Opin Clin Nutr Metab Care.2010; 13:170-176.
- Cahill NE, Dhaliwal R, Day AG, Jiang X, Heyland DK. Nutritiontherapy in the critical care setting: ¿what is “best achievable” practice? An international multicenter observational study. Crit Care Med.2010; 38:395-401. doi: 10.1016 / j. clnu.2020.04.023
- Yeh DD, Fuentes E, Quraishi SA, et al. Adequate nutrition may get youhome:effect of caloric/protein deficits on the discharge destination ofcritically ill surgical patients. J Parenter Enteral Nutr. 2016; 40:37-44. doi: 10.1177 / 0148607115585142
- Reintam Blaser A, Jakob SM, Starkopf J. Gastrointestinal failure inthe ICU. Curr Opin Crit Care. 2016; 22:128-141. doi: 10.1097 / MCC.0000000000000286
- Wang K, McIlroy K, Plank LD, Petrov MS, Windsor JA. Prevalence, outcomes, and management of enteral tube feeding intolerance. A retrospective cohort study in a tertiary center. J Parenter Enteral Nutr.2017; 41:959-967. doi: 10.1177 / 0148607115627142
- Chapman MJ, Nguyen NQ, Deane AM. Gastrointestinal dysmotility: evidence and clinical management. Curr Opin Clin Nutr Metab Care.2013; 16:209-216. doi: 10.1097 / MCO.0b013e32835c1fa5
- Goates S, Du K, Braunschweig CA, Arensberg MB. Economic Burden
of Disease-Associated Malnutrition at the State Level. PLoS One.2016; 11: e0161833. doi: 10.1371 / journal.pone.0161833
- Asrani VM, Brown A, Huang W, Bissett I, Windsor JA. Gastrointestinal Dysfunction in Critical Illness: A Review of Scoring Tools. JPEN J Parenter Enteral Nutr. 2020; 44:182-196. doi:10.1002/jpen.1679
- Reintam Blaser, A., Starkopf, J., Alhazzani, W., Berger, M. M., Casaer, M. P., Deane, A. M., et al. ESICM Working Group on Gastrointestinal Function, E. W. G. on G. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Medicine. 2017; 43, 380–398. doi: 10.1007/s00134-016-4665-0
- Abhari S, Safdari R, Azadbakht L, et al. A Systematic Review of Nutrition Recommendation Systems: With Focus on Technical Aspects. J Biomed Phys Eng. 2019; 9:591-602. doi:10.31661/jbpe. v0i0.1248
- Mahmood S, Hoffman L, Ali IA, Zhao YD, Chen A, Allen K. Smart Phone/Device Application to Improve Delivery of Enteral Nutrition in Adult Patients Admitted to the Medical Intensive Care Unit. NutrMetabInsights. 2019; 12:1178638818820299. doi:10.1177/117863881882029
- Singer, P., ReintamBlaser, A., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, et al. ESPEN Guideline ESPEN guideline on clinical nutrition in the intensive care unit. 2019, doi: 10.1016/j.clnu.2018.08.037
- Badaró S, Ibañez Leonardo Javier y Agüero Martín J. Expertos: Fundamentos, Metodologías y Aplicaciones. Sebastián. Ciencia y Tecnología, 13, 2013, pp. 349-364 ISSN 1850-0870. Disponible en: https://www.palermo.edu/ingenieria/pdf2014/13/CyT_13_24.pdf
- Trtovac D, Lee J. The Use of Technology in Identifying Hospital Malnutrition: ScopingReview. JMIR Med Inform. 2018; 6: e4. doi: 10.2196/medinform.7601.
- North JC, Jordan KC, Metos J, Hurdle JF. Nutrition Informatics Applications in Clinical Practice: a Systematic Review. AMIA Annu Symp Proc. 2015 Nov 5; 2015:963-72. PMID: 26958233 PMCID: PMC4765562
- Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Med Internet Res. 2015; 17:e52. doi: 10.2196/jmir.3951.
- Reintam Blaser A, Preiser JC, Fruhwald S, Wilmer A, Wernerman J, Benstoem C, et al. Working Group on Gastrointestinal Function within the Section of Metabolism, Endocrinology and Nutrition (MEN Section) of ESICM. Gastrointestinal dysfunction in the critically ill: a systematic scoping review and research agenda proposed by the Section of Metabolism, Endocrinology and Nutrition of the European Society of Intensive Care Medicine. Crit Care. 2020 15; 24:224. doi: 10.1186/s13054-020-02889-4.
- Frantz DJ, McClave SA, Hurt RT, Miller K, Martindale RG. Cross-SectionalStudy of U.S. Interns' Perceptions of Clinical Nutrition Education. JPEN J Parenter Enteral Nutr. 2016; 40:529-35. doi: 10.1177/0148607115571016.
- Bernstam EV, Smith JW, Johnson TR. What is biomedical informatics? J Biomed Inform. 2010; 43:104-10. doi: 10.1016/j.jbi.2009.08.006.
- Pronovost PJ. Enhancing physicians' use of clinical guidelines. JAMA. 2013 18; 310:2501-2. doi: 10.1001/jama.2013.281334.
- McCoy AB, Waitman LR, Lewis JB, Wright JA, Choma DP, Miller RA. Et al. A framework for evaluating the appropriateness of clinical decision support alerts and responses. J Am Med Inform Assoc. 2012; 19:346-52. doi: 10.1136/amiajnl-2011-000185.
- Chu LF, Erlendson MJ, Sun JS, Alva HL, Clemenson AM. Mobile computing in medical education: opportunities and challenges. CurrOpin Anaesthesiol. 2012; 25:699-718. doi: 10.1097/ACO.0b013e32835a25f1.
- Taylor BE, McClave SA, Martindale RG, Warren MM, Johnson DR,Braunschweig C, et al. Guidelines for the provision and assessment ofnutrition support therapy in the adult critically ill patient: Society of CriticalCare Medicine (SCCM) and American Society for Parenteral and EnteralNutrition (A.S.P.E.N.). Crit Care Med. 2016; 44:390–438. doi:10.1097/CCM.0000000000001525
- Cederholm, T., Jensen, G. L., Correia, M., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., et al. GLIM Working Group. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clinical nutrition. 2019 38, 1–9. doi: 10.1016/j.clnu.2018.08.002
- Enriquez-Sánchez LB, Carrillo-Gorena MJ, Granados-Aldaz LA, Balderrama-Miramontes LF, Gallegos-Portillo LG, RezaLeal CN, et al. Intestinal failure functional classification type associated with an extended length of stay at the intestinal failure unit, Central Hospital in Chihuahua, Mexico. Cir. 2019; 87:559-63. doi: 10.24875/CIRU.19000767.
- Fuglsang KA, Brandt CF, Scheike T, Jeppesen PB. Hospitalizations in patients with nonmalignant short-bowel syndrome receiving home parenteral support. Nutr Clin Pract. 2020; 35:894-902. doi: 10.1002/ncp.10471.
- Køhler M, Olesen SS, Rasmussen HH. Body composition predicts clinical outcome in patients with intestinal failure on long-term home parenteral nutrition. Clin Nutr ESPEN. 2018; 28:193-200. doi: 10.1016/j.clnesp.2018.08.004.
- Hay T, Bellomo R, Rechnitzer T. Constipation, diarrhea, and prophylactic
laxative bowel regimens in the critically ill: a systematic review and metaanalysis. J Crit Care. 2019; 52:242–50. doi: 10.1016/j.jcrc.2019.01.004.
- Perez-Calatayud AA, Carrillo-Esper R, Anica-Malagon ED, Briones-Garduño JC, Arch-Tirado E, Wise R, Malbrain MLNG. Point-of-care gastrointestinal and urinary tract sonography in daily evaluation of gastrointestinal dysfunction in critically ill patients (GUTS Protocol). Anaesthesiol Intensive Ther. 2018; 50:40–8. doi: 10.5603/AIT.a2017.0073.
- Lewis K, Alqahtani Z, McIntyre L, Almenawer S, Alshamsi F, Rhodes A, et al.The efficacy and safety of prokinetic agents in critically ill patients receivingenteral nutrition: a systematic review and meta-analysis of randomized trials.Crit Care. 2016; 20:259. doi: 10.1186/s13054-016-1441-z
- Deane AM, Lamontagne F, Dukes GE, Neil D, Vasist L, Barton ME, et al.Nutrition adequacy therapeutic enhancement in the critically ill: arandomized double-blind, placebo-controlled trial of the motilin receptoragonist camicinal (GSK962040): the NUTRIATE Study. JPEN J Parenter EnteralNutr. 2018; 42:949–59. doi: 10.1002/jpen.1038.
- Oczkowski SJW, Duan EH, Groen A, Warren D, Cook DJ. The use of bowelprotocols in critically ill adult patients: a systematic review and metaanalysis. Crit Care Med. 2017; 45: e718–26. doi: 10.1097/CCM.0000000000002315.
- Brigode WM, Jones C, Vazquez DE, Evans DC. Scrutinizing the evidence linking hypokalemia and ileus: a commentary on fact and dogma. Int JAcad Med. 2015; 1:21–6. Disponible en: https://www.ijam-web.org/text.asp?2015/1/1/21/172705
- Barletta JF, Asgeirsson T, Senagore AJ. Influence of intravenous opioid doseon postoperative ileus. Ann Pharmacother. 2011; 45:916–23. doi:10.1345/aph.1Q041.
- Rubinoff MJ, Piccione PR, Holt PR. Clonidine prolongs human small intestinetransit time: use of the lactulose-breath hydrogen test. Am J Gastroenterol.1989;84:372–4. PMID: 2929556
- Martos-Benítez FD, Gutiérrez-Noyola A, Soto-García A, González-Martínez I, Betancourt-Plaza I. Program of gastrointestinal rehabilitation and early postoperative enteral nutrition: a prospective study. Updates Surg. 2018; 70:105-112. doi: 10.1007 / s13304-018-0514-8
- Ricciardi R, Roberts PL, Read TE, Hall JF, Marcello PW, Schoetz DJ. Which adverse events are associated with mortality and prolonged length of stay following colorectal surgery? J GastrointestSurg. 2013; 17:1485-93. doi: 10.1007/s11605-013-2224-3.
- Karagozian R, Johannes RS, Sun X, Burakoff R. Increased mortality and length of stay among patients with inflammatory bowel disease and hospital-acquired infections. Clin Gastroenterol Hepatol. 2010; 8:961-5. doi: 10.1016/j.cgh.2010.07.017.
- Fuglsang KA, Brandt CF, Scheike T, Jeppesen PB. Hospitalizations in Patients with Non malignant Short-Bowel Syndrome Receiving Home Parenteral Support. Nutr Clin Pract. 2020;35(5):894-902. doi: 10.1002/ncp.10471.
Downloads
Publicado
Como Citar
Licença
Copyright (c) 2022 Nutrición Clínica y Dietética Hospitalaria
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Los lectores pueden utilizar los textos publicados de acuerdo con la definición BOAI (Budapest Open Access Initiative)
