Nutrição perioperatória 360: um modelo de cuidados baseado em provas
Nutrição perioperatória
DOI:
https://doi.org/10.12873/423pinzonPalavras-chave:
Palavras-chave: Arginina; Ácidos gordos. Nucleotídeos; Cirurgia Geral; Apoio Nutricional; Análise de Custos.Resumo
Abstrato
A presente revisão da literatura permite-nos propor um modelo de acção para a identificação atempada de pacientes que requerem grandes cirurgias e que podem beneficiar de intervenções nutricionais tais como a imunonutrição com base em provas científicas. Metodologicamente, incluiu uma revisão rápida da literatura, consultando as seguintes fontes de dados: EMBASE, MEDLINE (Pubmed), Cochrane Database of Systematic Reviews (Wiley), LILACS (BVS, interface iAHx) e o motor de busca Google Scholar. Como resultado, foram identificados 40 artigos, que cumpriam os parâmetros estabelecidos para a revisão sistemática e os critérios de qualidade, que permitiram estabelecer quatro fases para a proposta de intervenção nutricional 360 na gestão nutricional perioperatória, rastreio nutricional de rotina em ambulatório, suplementação pré-operatória com doses terapêuticas de imunonutrição, intervenção nutricional intra-hospitalar e acompanhamento nutricional pós-operatório. Em conclusão, um modelo de intervenção nutricional que inclui uma contribuição nutricional com uma fórmula de aminoácidos (arginina e/ou glutamina), ácidos gordos polinsaturados (ácido gordo ómega 3) e uma mistura de nucleótidos ou RNA, é uma estratégia rentável em pacientes de cirurgia electiva para cancro gastrointestinal (cancro do estômago e do cólon), cirurgia da cabeça e do pescoço, pacientes com mais de 18 anos de idade.
Referências
Drover JW.; Dhaliwal R, Weitzel L, Wischmeyer PE, Ochoa JB, Heyland DK. Perioperative use of arginine-supplemented diets: a systematic review of the evidence. J Am Coll Surg. 2011;212(3):385-399.e1.
Martindale RG.; McClave SA, Taylor B, Lawson CM. Perioperative nutrition: what is the current landscape?. JPEN J Parenter Enteral Nutr. 2013;37(5 Suppl):5S-20S.
Arends J.; Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11-48.
Schwegler I.; von Holzen A, Gutzwiller JP, Schlumpf R, Mühlebach S, Stanga Z. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg. 2010;97(1):92-97.
Yu K; Zheng X, Wang G, et al. Immunonutrition vs Standard Nutrition for Cancer Patients: A Systematic Review and Meta-Analysis (Part 1). JPEN J Parenter Enteral Nutr. 2020;44(5):742-767.
Cerantola Y.; Hübner M, Grass F, Demartines N, Schäfer M. Immunonutrition in gastrointestinal surgery. Br J Surg. 2011;98(1):37-48.
Probst P.; Ohmann S, Klaiber U, et al. Meta-analysis of immunonutrition in major abdominal surgery. Br J Surg. 2017;104(12):1594-1608.
Soares AD.; Costa KA, Wanner SP, et al. Dietary glutamine prevents the loss of intestinal barrier function and attenuates the increase in core body temperature induced by acute heat exposure. Br J Nutr. 2014;112(10):1601-1610.
Efron D.; Barbul A. Role of arginine in immunonutrition. J Gastroenterol. 2000;35 Suppl 12:20-23.
Martin JM.; Stapleton RD. Omega-3 fatty acids in critical illness. Nutr Rev. 2010;68(9):531-541.
Marik PE.; Zaloga GP. Immunonutrition in high-risk surgical patients: a systematic review and analysis of the literature. JPEN J Parenter Enteral Nutr. 2010;34(4):378-386.
Mauskopf JA.; Candrilli SD, Chevrou-Séverac H, Ochoa JB. Immunonutrition for patients undergoing elective surgery for gastrointestinal cancer: impact on hospital costs. World J Surg Oncol. 2012;10:136.
Waitzberg DL.; Saito H, Plank LD, et al. Postsurgical infections are reduced with specialized nutrition support. World J Surg. 2006;30(8):1592-1604.
Dobbins, M. "Rapid review guidebook." Natl. Collab. Cent. Method Tools 13 (2017): 25.
Meijers JM.; Tan F, Schols JM, Halfens RJ. Nutritional care; do process and structure indicators influence malnutrition prevalence over time?. Clin Nutr. 2014;33(3):459-465.
Geiker NR.; Horup Larsen SM, Stender S, Astrup A. Poor performance of mandatory nutritional screening of in-hospital patients. Clin Nutr. 2012;31(6):862-867.
de Las Peñas R.; Majem M, Perez-Altozano J, et al. SEOM clinical guidelines on nutrition in cancer patients (2018). Clin Transl Oncol. 2019;21(1):87-93.
Thompson KL.; Elliott L, Fuchs-Tarlovsky V, Levin RM, Voss AC, Piemonte T. Oncology Evidence-Based Nutrition Practice Guideline for Adults. J Acad Nutr Diet. 2017;117(2):297-310.e47.
Braga M. Perioperative immunonutrition and gut function. Curr Opin Clin Nutr Metab Care. 2012;15(5):485-488.
Cheng Y.; Zhang J, Zhang L, Wu J, Zhan Z. Enteral immunonutrition versus enteral nutrition for gastric cancer patients undergoing a total gastrectomy: a systematic review and meta-analysis. BMC Gastroenterol. 2018;18(1):11. Published 2018 Jan 16.
Ida S.; Hiki N, Cho H, et al. Randomized clinical trial comparing standard diet with perioperative oral immunonutrition in total gastrectomy for gastric cancer. Br J Surg. 2017;104(4):377-383.
Song GM.; Liu XL, Bian W, et al. Systematic review with network meta-analysis: comparative efficacy of different enteral immunonutrition formulas in patients underwent gastrectomy. Oncotarget. 2017;8(14):23376-23388.
Braga M.; Wischmeyer PE, Drover J, Heyland DK. Clinical evidence for pharmaconutrition in major elective surgery. JPEN J Parenter Enteral Nutr. 2013;37(5 Suppl):66S-72S.
Weimann A.; Braga M, Harsanyi L, et al. ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin Nutr. 2006;25(2):224-244.
McClave SA.; Kozar R, Martindale RG, et al. Summary points and consensus recommendations from the North American Surgical Nutrition Summit. JPEN J Parenter Enteral Nutr. 2013;37(5 Suppl):99S-105S.
Ali Abdelhamid Y.; Chapman MJ, Deane AM. Peri-operative nutrition. Anaesthesia. 2016;71 Suppl 1:9-18.
Banerjee S.; Garrison LP, Danel A, Ochoa Gautier JB, Flum DR. Effects of arginine-based immunonutrition on inpatient total costs and hospitalization outcomes for patients undergoing colorectal surgery. Nutrition. 2017;42:106-113.
Ukleja A.; Gilbert K, Mogensen KM, et al. Standards for Nutrition Support: Adult Hospitalized Patients. Nutr Clin Pract. 2018;33(6):906-920.
Burden S.; Todd C, Hill J, Lal S. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev. 2012;11:CD008879.
Lewis SJ.; Andersen HK, Thomas S. Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis. J Gastrointest Surg. 2009;13(3):569-575.
Steed HL.; Capstick V, Flood C, Schepansky A, Schulz J, Mayes DC. A randomized controlled trial of early versus "traditional" postoperative oral intake after major abdominal gynecologic surgery. Am J Obstet Gynecol. 2002;186(5):861-865.
Lewis SJ.; Egger M, Sylvester PA, Thomas S. Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ. 2001;323(7316):773-776.
Braga M.; Ljungqvist O, Soeters P, et al. ESPEN Guidelines on Parenteral Nutrition: surgery. Clin Nutr. 2009;28(4):378-386.
McClave SA.; Martindale R, Taylor B, Gramlich L. Appropriate use of parenteral nutrition through the perioperative period. JPEN J Parenter Enteral Nutr. 2013;37(5 Suppl):73S-82S.
Yanok RMP.; SA IIM, Chau SH, SENG KJSM. A Systematic Review on the Effectiveness of Enteral Immunonutrition (EIN) on Pre-and Post-Operative Outcomes in Gastric Cancer Patients. 2020;49(3):625-34.
Xu J.; Sun X, Xin Q, et al. Effect of immunonutrition on colorectal cancer patients undergoing surgery: a meta-analysis. Int J Colorectal Dis. 2018;33(3):273-283.
Braga M.; Gianotti L. Preoperative immunonutrition: cost-benefit analysis. JPEN J Parenter Enteral Nutr. 2005;29(1 Suppl):S57-S61.
Barreiro E.; Sánchez R, Diz S, Piñeiro A, Seoane J, Carrera E. Impacto de la terapia con inmunonutrición oral perioperatoria en pacientes sometidos a cirugía por cáncer colorrectal [Impact of preoperative oral nutrition therapy in patients undergoing surgery for colorectal cancer]. Nutr Hosp. 2019;36(5):1150-1156.
Weimann A.; Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr. 2021;40(7):4745-4761.
Fujitani K.; Tsujinaka T, Fujita J, et al. Prospective randomized trial of preoperative enteral immunonutrition followed by elective total gastrectomy for gastric cancer. Br J Surg. 2012;99(5):621-629.
Marano L.; Porfidia R, Pezzella M, et al. Clinical and immunological impact of early postoperative enteral immunonutrition after total gastrectomy in gastric cancer patients: a prospective randomized study. Ann Surg Oncol. 2013;20(12):3912-3918.
Reeves C.; Deeks J, and Higgins J.P. "13 Including non-randomized studies." Cochrane handbook for systematic reviews of interventions 1 (2008): 391.
Williams D.; Molinger J, Wischmeyer P. The malnourished surgery patient: a silent epidemic in perioperative outcomes?. Curr Opin Anaesthesiol. 2019;32(3):405-411.
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