Trata-se de um estudo observacional, retrospectivo, cujo objetivo foi descrever o perfil dos pacientes e características da Terapia Nutricional Enteral (TNE) bem como analisar as complicações dessa terapia e os fatores associados em pacientes adultos hospitalizados. O estudo constituiu-se de uma amostra de 214 pacientes internados, no período de 2008 e 2009, em um hospital universitário do Município de São Paulo. Os dados foram coletados dos prontuários e das fichas de avaliação nutricional, em um formulário elaborado para o estudo. Os resultados permitiram verificar que: 1 a-) em relação ao perfil dos pacientes e terapia nutricional enteral, houve predominância do sexo masculino (55,6%), com média de idade de 64,8 anos; internados em unidades de semi-intensiva e UTI (66,8%). b-) Referente à terapia nutricional enteral, a média de dias de nutrição enteral foi de 13,2 dias, e 43,5% dos pacientes receberam-na em até uma semana. Quanto à via de acesso enteral, predominaram as sondas nasoenterais (96,3%) e o método de administração contínuo da dieta (67,3%). 2-) em relação às complicações da TNE e os eventos observados - dos 214 pacientes da amostra, em 200 deles houve complicações durante o uso da nutrição enteral. Verificou-se a ocorrência de complicações: gastrointestinal (90,5%), metabólica (55,0%), mecânica (41,5%) e pulmonar (13,0%). Os eventos observados mais frequentes da complicação gastrointestinal foram: distensão abdominal (33,4%), constipação (17,5%) e alto volume residual gástrico (14,6%). Na complicação metabólica, o evento observado foi hiperglicemia (55,0%), com valor médio de 174,2 mg/dL. Os eventos observados predominantes da complicação mecânica foram: saída não programada da sonda enteral (70,5%), seguida de obstrução da sonda enteral (19,0%). Na complicação pulmonar, a aspiração pulmonar (13,0%) foi o evento observado. 5-) Quanto ao método de infusão houve associação significativa da infusão contínua com os seguintes eventos observados na complicação gastrointestinal: alto VRG (p=0,000), constipação (p=0,010), distensão abdominal (p=0,037). Na complicação mecânica, houve associação significativa com a infusão intermitente nos seguintes eventos: saída não programada da sonda enteral (p=0,005) e deslocamento da sonda enteral (p=0,040). 6-) Quanto à terapia medicamentosa, houve associação significativa da complicação metabólica (hiperglicemia) e o uso de sedativos/opioides (p=0,000) e drogas vasoativas (p=0,000). Este estudo demonstrou que as complicações coexistentes com a TNE são muito prevalentes nesta população (93,5%). Além disso, verificou-se que existe elevada ocorrência de eventos observados (617), sendo as complicações (400) que apresentaram intersecções significativas com outras variáveis acima descritas. Portanto, investigações das condições clínicas, as terapêuticas e os cuidados no uso da sonda enteral devem ser reiteradamente indicadas, sobretudo para os enfermeiros que são responsáveis pela administração e monitoramento da nutrição enteral. / This observational and retrospective study aimed to describe the profile of patients and the characteristics of the Enteral Nutrition Therapy (ENT), as well as to analyze the complications of this therapy and the associated factors in hospitalized adult patients. The study consisted of a sample of 214 patients, hospitalized between 2008 and 2009 at a university hospital in the city of São Paulo. Data were collected from medical records and of nutritional assessment sheets, using a form developed for the study. Results showed that: 1 a-) in relation to patient profiles and enteral nutrition therapy participants were predominantly male (55.6%), with an average age of 64.8 years, hospitalized in semi-intensive and intensive care units (66.8%); b-) Concerning enteral nutrition therapy, the average days of enteral nutrition was 13.2 days, and 43.5% of the patients received it for up to one week. As for the route of enteral access, nasoenteric feeding tube (96.3%) and continuous feeding administration (67.3%) were the most common. 2 -) regarding the complications of ENT and the observed events of the 214 patients of the sample, 200 had complications during the use of enteral nutrition. There was occurrence of gastrointestinal (90.5%), metabolic (55.0%), mechanical (41.5%) and pulmonary (13.0%) complications. The most frequently observed events among gastrointestinal complication were: abdominal distention (33.4%), constipation (17.5%) and high gastric residual volume (GRV) (14.6%). Among the metabolic complication, hyperglycemia (55.0%) was observed, with average of 174.2 mg/dL. The predominant events resulting from mechanical complication were unexpected withdrawal of enteral feeding tube (70.5%), followed by obstruction of enteral feeding tube (19.0%). As for pulmonary complication, pulmonary aspiration (13.0%) was the observed event. 5-) Concerning the method of infusion, there was significant association of continuous infusion with the following events observed in gastrointestinal complication: high GRV (p=0.000), constipation (p=0.010) and abdominal distension (p=0.037). Among the mechanical complication, there was significant association with intermittent infusion at the following events: unexpected withdrawal of enteral feeding tube (p=0.005) and displacement of enteral feeding tube (p=0.040). 6-) Regarding drug therapy, there was significant association of metabolic complication (hyperglycemia) and use of sedatives/opioids (p=0.000) and vasoactive drugs (p=0.000). This study evidenced that complications concomitant with ENT are very prevalent in this population (93.5%). Moreover, it was found that there is a high occurrence of observed events (617), with complications (400) presenting significant intersections with other variables described above. Therefore, research on the clinical conditions, treatments and care to the use of enteral feeding tubes should be constantly indicated, particularly for nurses who are responsible for the administration and monitoring of enteral nutrition.

Orientador: Solange Cadore / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Química / Made available in DSpace on 2018-08-20T11:04:06Z (GMT). No. of bitstreams: 1 Macarovscha_GreiceTrevisan_D.pdf: 1199412 bytes, checksum: 01812e9a216e254f6aa24ef19b35b304 (MD5) Previous issue date: 2011 / Resumo: A nutrição enteral é um alimento com finalidade de suprir todas as necessidades nutricionais de um indivíduo que está incapacitado de se alimentar da forma convencional. São alimentos encontrados comercialmente em forma sólida ou liquida, prontos para o consumo, cuja composição inclui carboidratos, proteínas, lipídios, vitaminas e minerais em quantidades suficientes para atingir a ingestão diária recomendada para um indivíduo saudável. A legislação brasileira regula os elementos metálicos essenciais e o limite máximo de contaminantes em alimentos. Para o estudo dessas espécies metálicas nas nutrições enterais, as técnicas de ICP OES e GF AAS foram utilizadas. As amostras foram analisadas por ICP OES após o tratamento em forno de microondas fechado. Após a otimização das condições experimentais do ICP OES (potência da RF, vazão de nebulização e vazão auxiliar) as espécies Al, As, Ba, Ca, Cd, Co, Cr, Cu, Fe , Hg, K , Mg, Mn, Mo, Na, Ni, Pb, Sb, Se, V e Zn tiveram sua exatidão avaliada através de experimentos de adição e recuperação, obtendo-se valores entre 90 e 110% e RSD menores que 5%, para a maior parte dos elementos. Ca, Fe, K, Mg, Mn, Na e Zn foram quantificados nas amostras enquanto que as espécies contaminantes (Cd, Hg, Pb e Se) e outros elementos essenciais (Cu, Cr, Mo, Se) não puderam ser quantificados pois estavam abaixo do LOQ do método. Com as condições de GF AAS (tempo e temperatura de pirólise e de atomização, uso de modificador químico) otimizadas e as amostras suspensas em CFA-C foram obtidas exatidões adequadas e RSD menores que 5% para as determinações de Al nas amostras. Diferentes tipos de embalagem não influenciaram o teor de Al nas amostras. Chumbo e cádmio também foram determinados por GF AAS, usando amostras mineralizadas em forno de micro-ondas fechado. Nas condições experimentais otimizadas a exatidão foi avaliada por um estudo de recuperação obtendo-se recuperações adequadas. O LOQ para Pb e Cd atendem os valores da legislação vigente. Essas espécies foram quantificadas nas amostras e todos os resultados observados se encontram abaixo do limite máximo tolerado de contaminantes. Um estudo de disponibilidade foi feito para avaliar a fração disponível dos elementos metálicos declarados na amostra. Esse estudo foi realizado in vitro, visando uma simulação dos processos digestivos e de absorção que ocorrem no trato gastrointestinal de um indivíduo. Os resultados mostraram que a disponibilidade dos elementos estudados nas amostras de nutrição enteral tornam esse tipo de alimento adequado para o seu fim / Abstract: Enteral nutrition is a food that aims to supply all the nutritional necessities of a person who is incapable of feeding in the conventional way. They are meals commercially available in solid or liquid forms, usually ready for consumption. These commercial meals include carbohydrates, proteins, lipids, vitamins and minerals in sufficient quantities in their composition, in order to reach the daily recommended amounts for a healthy individual. Brazilian legislation regulates the essential metallic elements and the maximum contaminants in food. For the study of metallic elements in enteral nutriments, the techniques of ICP-OES and GF AAS were used. ICP OES was used for the analysis after sample treatment in a closed microwave oven. After experimental optimization of the ICP OES parameters (RF power, nebulization flow, and auxiliary flow) the method accuracy was evaluated using addition and recovery experiments. For the majority of the elements recoveries between 90 and 110% and RSD less than 5% were obtained. Ca, Fe, K, Mg, Mn, Na and Zn were quantified in the samples. The contaminants species (Cd, Hg, Pb, Se) and the other essential elements (Cr, Cu, Mo, Se) were below the LOQ and could not be quantified. Using GF AAS optimized conditions (pyrolysis and atomization time and temperature and use of chemical modifiers) with the samples suspended in CFA-C it was possible to obtain adequate accuracies and RSD lower than 5% for the determination of Al in the enteral samples. Different types of packaging did not influence the content of Al in the samples. Lead and Cd were determined by GF AAS after sample treatment by microwave radiation. Under the optimized experimental conditions the method accuracy was evaluated by an addition and recovery study. The LOQ for Pb and Cd using GF AAS are in accordance with the values established by the legislation. The determination of Cd and Pb showed that the concentrations in all the samples analyzed are below the maximum tolerated value. A bioavailability study was carried out to evaluate the available fraction of the metallic elements declared in the sample¿s label. The in vitro study simulated the digestive and absorption processes that occur in the gastrointestinal treat of an individual. The results showed that the availability of elements in the samples of enteral nutrition make this type of food suitable for their purpose / Doutorado / Quimica Analitica / Doutor em Ciências

Orientador: Maria Isabel Pedreira de Freitas / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T21:36:43Z (GMT). No. of bitstreams: 1 Santos_SandraCristinaVeigadeOliveira_M.pdf: 1548989 bytes, checksum: 9e03f859b84dcaf467adf1cafdcb51ee (MD5) Previous issue date: 2012 / Resumo: Introdução: Para assegurar o depósito de nutrientes de forma segura é necessário que a sonda enteral esteja bem posicionada. Estudos com evidência científica vêm demonstrando a ocorrência de erros na colocação dessas sondas. Para se confirmar sua localização há procedimentos realizados à beira do leito que carecem de eficácia na assertividade. O exame radiológico é uma maneira recomendada pela literatura internacional como padrão para confirmação da locação da sonda enteral, mas tem restrições quanto a seu uso já descritas. Medidas preconizadas para sua inserção ensinadas nas escolas de enfermagem não vêm associadas a dados de evidência científica que comprovem segurança para sua utilização. Objetivos: Verificar os fatores limitantes para a definição de uma medida para introdução de sonda enteral em posição gástrica em adultos, verificando a acurácia de uma medida pré-estabelecida para introdução da sonda, suas limitações e a contribuição do exame radiológico para validação do posicionamento da sonda enteral. Sujeitos e Métodos: Estudo descritivo, exploratório, com abordagem quantitativa e corte transversal. Aprovado pelo Parecer CEP 983/2010. Estudo-piloto com 17 pacientes modificou o desenho metodológico. O estudo definitivo foi realizado com 53 pacientes, adultos, de ambos os sexos, maiores de 18 anos, internados em hospital universitário, entre outubro de 2011 a fevereiro de 2012. Foram inseridas sondas de poliuretano para alimentação em pacientes, com prescrição médica de sonda enteral. Elaborado protocolo diretivo para a inserção das sondas. Um médico radiologista analisou o exame radiológico em dois momentos: com e sem o fio-guia. Resultados: 53 pacientes, internados em um hospital universitário, receberam sonda enteral em posição gástrica. Dos 39,6% pacientes que apresentaram eventos adversos, 81% estavam contidos no leito. Os eventos adversos foram: epistaxe em 9,4%; retorno de sangue pela sonda na retirada do fio-guia em 1,9%; dificuldade em posicionar o paciente para se obter a medida a ser usada na introdução da sonda devido sua condição clínica em 17% e ausência de um dos pontos anatômicos (cicatriz umbilical) em 5,6%. O exame radiológico demonstrou que a medida estabelecida no estudo anterior teve sucesso de posicionamento em 92,4% dos casos. Conclusões: Fatores limitantes para introdução da sonda enteral demonstraram a complexidade do procedimento e sua realização; exige capacitação dos recursos humanos e medidas para se garantir risco zero ao paciente. As maneiras de se comprovar a localização da sonda no local correto para se infundir os nutrientes estão embasadas em recomendações empíricas. Há necessidade de estudos aprofundados para que o procedimento seja seguro ao paciente. O exame radiológico embora considerado padrão, demonstrou não ser 100% seguro para confirmação da locação da sonda enteral. A validação final da medida estabelecida em estudo anterior para se introduzir a sonda enteral em adulto, em posição gástrica, não foi efetivada por deficiências de metodologia. Há falta de evidência para se realizar o procedimento da inserção da sonda de alimentação sem risco ao paciente / Abstract: Introduction: To assure the safe and effective delivery of nutrients to the patient, the enteral feeding tube must be correctly located in the stomach. However, scientific studies have shown that the tubes are often placed out of the ideal location. To there are bedside procedures to confirm tube location, which are not aways effective. The x-ray imaging is the procedure recommended in the international literature, as ideal to confirm the location of the enteral tube, but is subjected to constraints already reported. The technique of measuring the length of the enteral feeding tube to be inserted into the stomach, which is taught in nursing courses, is not based on scientific evidence ensuring the procedure safeness. Objectives: To verify the limiting factors for the definition of a safe measure of the length to the introduction of the enteral feeding tube at gastric position in adults. The accuracy and limitations of a pre-defined standard technique to measure the length of the enteral feeding tube location and the contribution of the x-ray imaging for the validation of tube positioning are also verified. Subjects and Methods: Descriptive and exploratory study with quantitative approach and transversal cross-section. Approved by CEP Report 983/2010. Pilot study with 17 patients modified the methodological design. The definitive study was carried out with 53 patients, adults, both genders, age over 18, inpatient in university hospital, between October 2011 and February 2012. Polyurethane tubes for feeding were inserted in patients to whom had been prescribed enteral tube. A protocol to be used as guideline for tube insertion was developed. A radiologist interpreted the X-ray image at two stages: with a guidewire and without it. Results: 53 patients in the university had the enteral tube inserted at gastric position. From 39.6% of patients presenting adverse events, 81% were restrained to bed. The adverse events were: epistaxis in 9.4%; blood reflux through tube during guidewire removal in 1.9%; difficult of positioning the patient to obtain the measure of the tube length to be inserted, due to its clinical condition in 17% and absence of anatomic marks (umbilical cicatrix) in 5.6%. The X-ray imaging demonstrated that the measure established in the previous study resulted in successful location in 92.4% of the cases. Conclusions: There are limiting factors for the insertion of the feeding tube, which demonstrate that this is a complex procedure and its use demands personnel training and measures to assure zero risk to the patient. The techniques to confirm the tube location to keep nutrient infusion are based on empirical recommendations. In-depth studies are necessary to make the procedure safe to the patient. The X-ray imaging, although considered the standard procedure, showed not to be 100% certain to confirm feeding tube location. The final validation of the measure for the insertion of the enteral feeding tube in adults, at gastric position, found in a previous study could not be consolidated due to methodological limitations. There is lack of data evidencing that this tube insertion procedure does not bring risk to the patient / Mestrado / Enfermagem e Trabalho / Mestra em Ciências da Saúde

Objetivo: trata-se de revisão integrativa da literatura realizada com o objetivo de identificar os estudos primários que abordam os eventos adversos relacionados à sonda nasogástrica / nasoentérica (SNG/SNE) em pacientes adultos. Método: a busca foi realizada no mês de abril de 2017 nas bases de dados PubMed, CINAHL, LILACS, EMBASE e Scopus. Para realizar a busca foram utilizadas palavras-chave e encontradas 1.020 citações. Destas, 988 artigos foram excluídos a partir da leitura de títulos e resumos. Em seguida, procedeu-se a leitura, na íntegra, de 32 artigos, dos quais 12 foram excluídos. Logo, um total de 20 artigos foram incluídos no estudo. Foi realizada, também, busca manual nas referências dos artigos incluídos com o intuito de encontrar estudos que não foram recuperados anteriormente nas bases de dados supracitadas. Foram obtidos 84 artigos, dos quais 30 foram excluídos, a partir da leitura de títulos e resumos. Dos 54 artigos recuperados, quatro foram excluídos após leitura na íntegra e um artigo durante a extração dos dados. Resultados: para esta revisão integrativa, foram incluídos um total de 69 artigos. Os dados foram analisados e posteriormente classificados em duas categorias principais que evidenciaram os eventos adversos relacionados ao uso de SNG/SNE: incidentes mecânicos (complicações respiratórias, complicações no esôfago ou faringe, obstrução da sonda, perfuração intestinal, perfuração intracraniana e saque não planejado da sonda) e outros incidentes (lesão por pressão relacionada à fixação e conexão errada). A maior parte dos artigos recuperados foi incluída na subcategoria \"complicações respiratórias\" devido ao posicionamento inadequado da extremidade distal da sonda no trato respiratório, o que resultou em pneumotórax e/ou óbito. Outros eventos adversos estavam relacionados à obstrução da sonda, perda da mobilidade das cordas vocais, perfuração intestinal com consequente infecção, lesão na pele e mucosas, e queimadura corporal devido à desconexão. Conclusão: os resultados sintetizados nesta revisão permitem que os profissionais da saúde, especialmente os da enfermagem, reflitam sobre a segurança dos pacientes em uso de SNG/SNE e que repensem a maneira como as sondas estão sendo manuseadas na prática clínica / Objective: an integrative literature review was developed to identify the primary studies on the adverse events related to nasogastric / nasoenteral tubes (NGT/NET) in adult patients. Method: the search was undertaken in April 2017 in the databases PubMed, CINAHL, LILACS, EMBASE and Scopus. Keywords were used for the search and 1,020 citations were found. After reading titles and abstract, 988 of these articles were excluded. Next, 32 articles were fully read, 12 of which were excluded. Hence, in total, 20 articles were included in the study. In addition, a manual search was undertaken in the references of the included articles, aiming to find studies that had not been retrieved earlier in the abovementioned databases. Eighty-four articles were found, 30 of which were excluded after reading the titles and abstracts. Of the 54 retrieved articles, four were excluded after reading the full version and one article during the extraction of the data. Results: for this integrative review, in total, 69 articles were included. The data were analyzed and then classified in two main categories that evidenced the adverse events related to the use of NGT/NET: mechanic incidents (respiratory complications, esophageal or pharyngeal complications, tube obstruction, intestinal perforation, intracranial perforation and unplanned tube withdrawal) and other incidents (wrong connection and fixationrelated pressure ulcer). Most of the articles were included in the subcategory \"respiratory complications\" due to improper positioning of the distal end of the tube in the respiratory tract, resulting in pneumothorax and/or death. Other adverse events were related to tube obstruction, loss of vocal chord mobility, intestinal perforation with consequent infection, skin and mucous membrane ulcers, and body burns due to detachment. Conclusion: based on the results synthesized in this review, health professionals, especially in nursing, can reflect on the safety of patients using NGT/NET and reconsider the manipulation of the tubes in clinical practice

O objetivo geral deste trabalho foi elaborar formulados alternativos, à base de mistura de alimentos convencionais, provenientes da cesta básica distribuída por entidades do município de Piracicaba-SP, entre outros alimentos, com o intuito de suplementar a alimentação enteral de idosos. Os alimentos utilizados para a elaboração dos formulados foram fubá, óleo de soja, arroz, feijão, macarrão, sardinha, leite em pó, amido de milho, ovos, proteína texturizada de soja, couve- manteiga e cenoura. Foram realizadas análises físicas: gotejamento e viscosidade; análises químicas: composição centesimal, digestibilidade de proteína, determinação do mineral ferro, diálise de ferro in vitro, determinação de -caroteno e fatores antinutricionais, assim como fenólicos totais e ácido fítico; análises microbiológicas: Salmonella, Bacillus cereus, Estafilococos coagulase positiva e Coliformes totais; análise de custos dos formulados e elaboração do manual de boas práticas de manipulação. Os resultados obtidos foram submetidos às análises estatísticas, empregando-se o teste de Tukey, utilizando o software SAS (1996) e análises de regressão, pelo programa Microsoft Office Excel (2003). Concluiuse, com esse estudo, que os formulados líquidos apresentaram os melhores resultados nutricionais, físicos, microbiológicos, e a maior viabilidade econômica, sendo, por isso, sugeridos para a suplementação enteral de idosos. Dentre eles, pode-se eleger uma entre duas alternativas, conforme a necessidade clinica do idoso, considerando-se todos os aspectos nutricionais e físicos dos formulados. O formulado F3 destacou-se nas seguintes características: disponibilidade de ferro, quantidades de -caroteno, digestibilidade, viscosidade e gotejamento. Já o formulado F4 teve destaque na distribuição do valor calórico total de macronutrientes, apresentando valores ideais para os idosos, segundo as recomendações internacionais, além do maior valor calórico entre os formulados e boa viscosidade e gotejamento. No que diz respeito ao valor calórico total, os formulados apresentaram de 131 a 216 calorias por 250ml, os tratamentos líquidos apresentaram valor calórico superior ao dos formulados em pó. Pode-se dizer que os formulados contribuem com percentual médio de 20% de adequação, em relação às recomendações de macronutrientes sugeridas pela DRI (2002) para idosos, quando ingeridas duas porções de 250mL/dia de formulados líquidos ou em pó. / The aim of this study was to develop alternative formulas for elderly enteral feeding using conventional foods from food staples distributed in the city of Piracicaba-SP. The foods used in the formulas were: corn meal, soya oil, rice, beans, pasta, sardine, powder milk, corn starch, eggs, texturized soya protein, cabbage, and carrot. Physical analyses (dripping and viscosity), chemical analyses (centesimal composition, protein digestibility, iron determination, iron dialyses in vitro, -carotene determination, anti-nutritional factors - tannins and phytate), microbiological analyses (Salmonella, Bacillus cereus, positive Staphylococcus coagulase and total Coliforms), cost analyses and elaboration of a manual for good manipulation practices were carried out. Results were analyzed statistically using Tukey test, SAS software (1996) and for regression using Microsoft Office Excel (2003). Liquid formulas presented better nutritional, physical and microbiological results as well as economical viability Therefore were suggested for elderly enteral nourishment. According to the elderly clinical needs, two alternatives are suggested among liquid formulas. The F3 formula is noticeable for iron availability, quantity of -carotene, digestibility, dripping and viscosity. The F4 formulas is noticeable for the total calorie distribution of macronutrients as well as for having a higher number of calories and good viscosity and dripping which is ideal for the elderly, according to international recommendations. The formulas presented a range of 131 to 216 calories/250ml. Liquid formulas presented higher number of calories than powder formulas. The formulas contributed with a 20% adequacy regarding to macronutrient recommendations for the elderly from DRI (2002), when two servings of 250mL.day-1 (powder or liquid) were ingested.

The incidence and causes of diarrhoea among critically ill patients receiving enteral tube feeding were investigated. Sixty acutely ill surgical or medical intensive care patients who had had a minimum of 48 hrs bowel rest were entered into the study. They were randomly assigned to receive one of two lactose free liquid formula diets - "Ensure", a commercially available feed containing 825 kCal/L and 34 g/L of protein with an osmolality of 441mOsm/1 or "Casilan Oil", a home-made feed containing 840 kCal /L and 45g/L of protein with an osmolality of 383 mOsm/1. The feeds were administered by constant nasogastric infusion. Patients received 1000ml at a rate of 40ml per hour for the first day and up to 2000ml at 80 ml per hour for the remainder of the study period. Investigations included documentation of medical history, medications administered and clinical details for each patient. Serum albumin was measured and the nutritional status of each patient was assessed using anthropometric measurements. Feeds were tested for bacterial contamination on the three days following the start of feeding and small intestinal bacterial overgrowth was assessed by the 1 g-¹⁴C Xylose breath test of Toskes and King. Twelve of the sixty patients had to be withdrawn from the trial within 24 hours of the start of enteral feeding for medical reasons. The remaining forty eight patients completed at least three days on enteral feeding and thereby became eligible for analysis. In 10/48 patients (21%) diarrhoea was present before enteral feeding began. Four of these 1 O patients continued to pass loose stools when enteral feeding was started while the remaining 6 settled. Diarrhoea developed in a further 10 patients (21%) after enteral feeding began. The overall incidence of diarrhoea in the group of critically ill patients studied was therefore 42% (20/48). However, of the fourteen patients who experienced diarrhoea during enteral feeding four had diarrhoea before feeding began. Therefore, the true incidence of diarrhoea related to enteral feeding was only 10/38 (26%). Furthermore, in 7 of these 10 patients, another possible cause of diarrhoea was present. There was no significant association between diarrhoea and nutritional status, hypoalbuminaemia, sepsis, length of bowel rest, sucralfate and antibiotic therapy other than amikacin. Twenty one patients received Ensure and 27 received Casilan Oil. Despite the differences in the composition of the feeds, the incidence of diarrhoea was similar on the Ensure and the Casilan Oil. No particular factor pertaining to the composition of the feeds was associated with diarrhoea. Significant contamination of feeds was universal but there was no constant relationship between bacterial counts, or types, and the occurrence of diarrhoea. Certain other factors were found to be significantly associated with diarrhoea. Abdominal injury was positively associated with the occurrence of diarrhoea (p<0.05). Diarrhoea could have been attributed to the underlying disease state in 7 of the patients. All three patients who were receiving lactulose as treatment for liver failure developed diarrhoea. While no association was noted between diarrhoea and antibiotic therapy in general, treatment with the antibiotic, amikacin, correlated significantly, albeit marginally, with the occurrence of diarrhoea (p<0.05). Twenty six patients were tested for small intestinal bacterial overgrowth. Only one patient, with an elevated excretion of ¹⁴CO₂, indicative of small intestinal bacterial overgrowth, developed diarrhoea. There was, however, a positive association between diarrhoea and decreased excretion of ¹⁴CO₂. It would appear that the bacterial flora was suppressed in patients with diarrhoea. Amikacin therapy was also associated with decreased excretion of ¹⁴CO₂. This may suggest that amikacin could have altered the bowel flora with resultant development of diarrhoea. While abdominal injury and disease were associated with the development of diarrhoea and amikacin was a possible factor associated with diarrhoea, the results of the present study indicate that enteral tube feeding with either the commercial feed, Ensure or the home-made feed, Casilan Oil was not a cause of diarrhoea in the majority of critically ill patients assessed. Furthermore, in most patients who commenced the trial with diarrhoea, improvement was noted on enteral feeding.

Bakgrund: Enteral nutrition via nasogastrisk sond är en vanlig behandlingsform för kortsiktig nutritionsbehandling då den anses ha förhållandevis lätt inläggning och avlägsnande. Sondinläggning och behandling kan innebära risker som kan leda till aspiration och allvarliga infektioner. Syfte: Syftet var att beskriva vuxna patienters erfarenheter och upplevelser av näringstillförsel via nasogastrisk sond. Metod: En allmän litteraturstudie genomfördes. Nio vetenskapliga artiklar med kvalitativ ansats bearbetades i en innehållsanalys. Resultat: Innehållsanalysen presenterar fyra teman: Erfarenheter och upplevelser av fysiskt obehag, Erfarenheter och upplevelser av ett begränsat liv, Erfarenheter och upplevelser av en förändrad identitet samt Erfarenheter och upplevelser av att hantera vardagen. Deltagare beskrev upplevelser av fysiskt obehag vid insättning av sonden och under själva behandlingen, samt erfarenheter av begränsningar i vardagen och uttryckte även en ovilja att lämna hemmet. Vidare beskrevs upplevelser av en försämrad självbild relaterat till sondens synliga placering samt copingstrategier och behovet av stöd från sjukvårdspersonal och familj. Slutsats: Deltagarna upplevde både positiva och negativa erfarenheter och upplevelser vilket resulterade i motstridiga känslor. Ett individanpassat stöd från sjukvårdpersonal kan ha stor inverkan på deltagarnas välbefinnande och möjlighet till att klara sitt dagliga liv. / Background: Enteral nutrition via nasogastric tube is a common treatment form for short-term nutritional support since intubation and removal are rather simple to perform. Tube intubation and treatment may entail risks of aspiration and serious infections. Aim: The aim was to describe adult patients' experiences of nutritional support via nasogastric tube. Method: A general literature study was implemented. Nine articles with a qualitative approach were analyzed through content analysis. Results: The content analysis present four themes: Experiences of physical discomfort, Experiences of a limited life, Experiences of a changed identity and Experiences of dealing with everyday life. Participants described experiences of physical discomfort during insertion and the treatment itself, and experiences of limitations in their everyday lives and expressed a reluctance to leave their homes. Furthermore, experiences of an impaired self-image related to the tube’s visible location was described as well as coping strategies and a need for support from healthcare personnel and family. Conclusion: Participants described both positive and negative experiences, which resulted in conflicted emotions. Receiving personalized support from healthcare personnel can have a major impact on the participants' well-being and ability to cope with their everyday lives.

Enteral nutrition (EN) is often delayed in critically ill patients despite strong evidence to support that early enteral nutrition feeding is beneficial in this population. Adverse outcomes in critically ill patients in which nutrition is delayed include a longer length of stay and time on the ventilator, and a higher incidence of pneumonia and hospital mortality. The purpose of this literature review was to evaluate the current evidence regarding trophic enteral feeds in mechanically ventilated adult patients with acute respiratory distress syndrome (ARDS)/acute lung injury (ALI) and associated clinical outcomes. A retrospective literature review was performed to identify articles published on the topic of trophic feeds in mechanically ventilated adult patients with ALI/ARDS, with a focus on associated clinical outcomes. The studies included in this literature review indicated that the dose and timing of enteral nutrition in critically ill patients with ARDS/ALI had an effect on clinical outcomes. It is possible that additional variables such as the level of organ dysfunction and varying definitions for trophic enteral nutrition also influenced clinical outcomes. The United States (U.S.) and Canadian guidelines for nutrition supportrecommend either trophic or full EN for patients with ARDS/ALI on the basis that these two feeding strategies have similar patient outcomes over the first week of hospitalization. After reviewing the literature, we conclude that caution is warranted when following this recommendation. Regressions suggest full calorie enteral nutrition administered early in the course of critical illness significantly increased the odds of mortality, whereas full calorie enteral nutrition administered later reduced the odds of mortality.

No description available.

La recolección de los datos se realizo en 191 pacientes que recibían nutrición enteral de la unidad de soporte nutricional del Hospital Edgardo Rebagliati Martins durante Junio-Agosto del 2003. En este período se observó que el 28.80% de estos pacientes recibieron Osmolite HN (NET) y medicación por sonda nasogástrica. Para el estudio In Vitro de diseño prospectivo y experimental se seleccionaron 15 medicamentos de acuerdo a la frecuencia de administración y al potencial riesgo farmacológico. Se observó para cada parámetro, la relación lineal entre las variables al adicionar NET a las suspensiones. Se evidenció un incremento en el valor de la viscosidad para el caso de la suspensión de Ciprofloxacino de 21 y 26.1 cps debido a la formación de gránulos densos en presencia del NET. La osmolalidad mostró la relación lineal entre la suspensión con la adición del NET (F=8.15, µ:0.05) a los 12, 36 y 60 minutos de infusión; no alcanzando valores máximos de 200mOsm/Kg, obteniéndose como máximo valor el de la Ranitidina con 186mOsm/Kg a los 60 minutos. Se evidenció que la adición del NET a la suspensión del Omeprazol disminuyó su acidez de 5.89 a 6.83, para el caso de la suspensión de Fenitoína el cual en presencia del NET y el aspirado gástrico se observo una disminución de su alcalinidad de 10.07 a 7.92 (µ:0.05). El valor medio de los valores de velocidad de caída para las suspensiones fue de 6”28 y con la adición del NET de 12”01 (µ:0.05), evidenciándose la ||obstrucción de la sonda para el caso de la suspensión de Ranitidina. La adsorción de Fenitoína de las proteínas del NET mostró que el mayor grado de unión se produjo a la 1:30 h (91.33%) y 3:00 h (89.10%); siendo 68.62% Fenitoína recuperada durante las 4 horas de infusión (µ:0.05). De acuerdo al estudio realizado se concluye que no todas las formas farmacéuticas pueden administrase con el nutriente enteral total por sonda nasogástrica por los cambios fisicoquímicos que la trituración genera. / The collection of the data was made in 191 patients that received nutrition enteral of the unit of supports nutritional of Hospital Edgardo Rebagliati Martins during June-August of the 2003. In this period we were observed that 28.80% of these patients received Osmolite HN and medication for nasogastric tube. For the study In Vitro of prospective and experimental design, 15 medications were selected according to the administration frequency and to the potential pharmacological risk. We were observed for each parameter, that lineal relationship among the variables when adding NET to the suspensions. The increment was evidenced in the value of the viscosity for the case of the suspension of Ciprofloxacino from 21 to 26.1 cps due to the formation of dense granules in presence of the NET. The osmolalidad showed the lineal relationship among the suspension with the addition of the NET (F=8.15, µ:0.05) to the 12, 36 and 60 minutes of infusion; not reaching maximum values of 200mOsm/Kg, obtaining the maximum value the Ranitidina with 186mOsm/Kg to the 60 minutes. We were evidenced with the addition of the NET to the suspension of the Omeprazol diminished its acidity from 5.89 to 6.83, for the case of the suspension of Fenitoina which in presence of the NET and aspired gastric observed a decrease of its alkalinity from 10.07 to 7.92 (µ:0.05). been evidenced the obstruction of the tube in the case of the suspension of Ranitidina. The adsorption of Fenitoína of the proteins of the NET evidenced that the biggest grade of union at the 1:30 h (91.33%) and 3:00 h (89.10%); being 68.62% Fenitoína recovered during the 4 hours of infusion (µ:0.05). According to the carried out study we concluded that not all the pharmaceutical forms can administers with the nutritious total enteral for nasogastric tube for the physiochemical changes that its trituration generates.