Submitted by Simone Souza (simonecgsouza@hotmail.com) on 2017-09-25T13:35:26Z No. of bitstreams: 1 DISS_2014_Vanessa Alvarenga Pegoraro.pdf: 1921327 bytes, checksum: dcf3ca8d3afb38e3634a7d5402c157e0 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-09-26T14:29:05Z (GMT) No. of bitstreams: 1 DISS_2014_Vanessa Alvarenga Pegoraro.pdf: 1921327 bytes, checksum: dcf3ca8d3afb38e3634a7d5402c157e0 (MD5) / Made available in DSpace on 2017-09-26T14:29:05Z (GMT). No. of bitstreams: 1 DISS_2014_Vanessa Alvarenga Pegoraro.pdf: 1921327 bytes, checksum: dcf3ca8d3afb38e3634a7d5402c157e0 (MD5) Previous issue date: 2014-07-18 / Introdução: Independente da administração continua ou intermitente, nas Unidades de Terapia Intensiva (UTI)geralmente o paciente recebe as suas necessidades nutricionais calculadas para a terapia nutricional enteral (TNE) em volume inferior ao programado, comprometendo sua recuperação. Assim, a interrupção programada da TNE em turno de realização das atividades de rotina diária dessas unidades, pode contribuir para diminuir este déficit. Objetivos:Avaliar em que período, diurno ou noturno, a interrupção na administração da terapia nutricional enteral no paciente crítico é mais eficaz para garantir as necessidades calculadas. Métodos:Estudo clínico, prospectivo, randomizado de abordagem quantitativa, em pacientes críticos internados em uma UTI Geral. Foram incluídos pacientes com idade maior que 18 anos, em uso de TNE exclusiva, observados nos primeiros cinco dias de dieta. Os pacientes no ato da indicação da TNE foram randomizados em dois grupos: Grupo I (18 horas de infusão de TNE – interrupção de 6h no período de 8h as 14h), e Grupo II (18 horas de infusão de TNE - com interrupção de 6h no período de 2h as 8h). Foram comparadas entre os grupos as seguintes variáveis: sexo, idade, Apache II, ASG, peso, necessidades calóricas, proteicas, volumes de dieta prescritos e infundidos. As variáveis quantitativas foram representadas por médias e desvio padrão. A normalidade dos dados pelo teste de Kolmogorov-Smirnov e sua homogeneidade pelo teste de Levene. A análise de dados foi realizada através do teste de análise de variância (ANOVA) e teste Post Hoc de Tukey. Para variáveis categóricas, o teste de qui-quadrado de Mantel-Haenszel ou Teste Exato de Fisher. Foi utilizado o programa SPSS versão 18.0 (α= 5%). Resultados: Os dados demográficos avaliados foram semelhantes entre os dois grupos. A avaliação de gravidade usando o APACHE II evidenciou grupos semelhantes (p=0,168). Na avaliação nutricional pela ASG, nenhum paciente dos dois grupos foi ASG- A, ASG-B 66,7% no grupo I e 86,7 % no grupo II, ASG-C 33,3 % e 13,3%, respectivamente, no grupos I e II (p=0,389). Peso médio idênticos em ambos os grupos (p=0,978). Comparando o volume infundido >60 % entre os grupos, no grupo I a infusão de dieta foi de 66,7 % versus 53,3%, no grupo II (p=0,463). E quanto ao alcance das metas de NC até o 3º dia de infusão, o grupo I obteve 13,3 % comparado ao grupo II com 6,7 % (p=0,549). E o alcance da NP no mesmo período, foi no grupo I comparado ao grupo II (20,0% versus 6,7%, p=0,290). Conclusão: Baseado nos resultados, podemos concluir que as necessidades de terapia nutricional enteral calculadas no paciente crítico são atingidas de forma semelhante tanto para interrupção diurna quanto noturna. / Introduction: Regardless of continuous or intermittent administration in the Intensive Care Unit (ICU) patients usually receive their nutritional requirements calculated for enteral nutrition therapy (ENT) in less than planned volume, hindering their recovery. Thus, the interruption of scheduled shift ENT in performing daily routine activities of these units can contribute to reduce this deficit. Objectives: To assess the period, day or night, the interruption in the administration of enteral nutritional therapy in critically ill patients is more effective to ensure the calculated requirements. Methods: clinical, prospective , randomized study of quantitative approach in critically ill patients hospitalized to a general ICU . Patients over 18 years old were included in the exclusive use of ENT, observed in the first five days of diet. Patients in the act of nomination of ENT were randomized into two groups: Group I (18 hours ENT infusion – break of 6 hours in the period of 8 a.m. to 2 p.m.) and Group II (18 hours ENT infusion - break of 6 hours in the period of 2 a.m. to 8 a.m.). Among the groups the following variables were compared: sex, age, Apache II, ASG, weight, calorie needs, protein, diet prescribed volumes and infused. The quantitative variables were represented by medium-sized and standard deviation. The normality of the data by the Kolmogorov-Smirnov test and its homogeneity by Levene's test. Data analysis was performed by testing analysis of variance (ANOVA) and Tukey test Post Hoc. For categorical variables, the Chi-square test of Mantel-Haenszel or Fisher's Exact Test. We used the program SPSS version 18.0 (α = 5%). Results: the demographics data assessed were similar between the two groups. The assessment of severity using APACHE II showed similar groups (p = 0.168). In nutritional evaluation by ASG, none of the patients of both groups was ASG-A, ASG-B, 66.7% in Group I and 86.7% in Group II, ASG-C 33.3% and 13.3%, respectively, in groups I and II (p = 0.389). There were average weight identical in both groups (p = 0.978). Comparing the volume infused > 60% between the groups, in the Group I the infusion of diet was 66.7% versus 53.3% in Group II (p = 0.463). And, as for achieving the goals of NC until the 3rd day of infusion, group I obtained 13.3% compared with 6.7% in Group II (p = 0.549). And, the achieving of the NP in the same period, was in Group I compared to group II (20.0% vs. 6.7%, p = 0.290). Conclusion: Based on the results, we can conclude that the needs of enteral nutrition therapy calculated in critical patient are affected in a similar manner for both daytime and nighttime interruption.

INTRODUÇÃO: Indicadores de qualidade em terapia nutricional (IQTN) são importantes ferramentas de avaliação e monitoramento de qualidade da terapia nutricional (TN). No Brasil, além da escassez de recursos humanos e materiais, a aplicação dos IQTNs,disponíveis para prática clínica, tem sido limitada devido ao seu elevado número. O presente estudo procurou identificar os dezIQTNs mais pontuados, dentre aqueles disponíveis no Brasil, através da avaliação da opinião de especialistas em TN. MÉTODOS: Todos os IQTNs disponíveis para aplicação clínica no Brasil (n=36) foram avaliados em duas fases distintas. Na fase 1 (seleção), especialistas em TN (n=26) pontuaramos IQTNs de acordo com quatro atributos (utilidade, simplicidade, objetividade, e baixo custo), utilizando a escala de Likert com 5 pontos. Os IQTNs foram classificadosem ordem da maior para menor pontuação e a confiabilidade da opinião de especialistas para cada indicador foi avaliada poralfa de Cronbach. Na fase 2, os dez IQTNs selecionados com maior pontuaçãoforam submetidos ànova análise dos especialistas, por meio de duas perguntas fechadas. RESULTADOS: Os dez IQTNs selecionadoscom maior pontuação, em ordem do mais para o menos pontuado, foram 1.) Frequência de realização de triagem nutricional em pacientes hospitalizados, 2.) Frequência de diarreia em pacientes em Terapia Nutricional Enteral, 3.) Frequência de saída inadvertida de sonda de nutrição em pacientes em Terapia Nutricional Enteral, 4.) Frequência de obstrução de sonda de nutrição em pacientes em Terapia Nutricional Enteral, 5.) Frequência de jejum digestório por mais de 24 horas em pacientes em Terapia Nutricional Enteral ou Oral, 6.) Frequência de pacientes com disfunção da glicemia em Terapia Nutricional Enteral e Parenteral, 7.) Frequência de medida ou estimativa do gasto energético e necessidades proteicas em pacientes em Terapia Nutricional, 8.) Frequência de infecção por Cateter Venoso Central em pacientes em Terapia Nutricional Parenteral, 9.) Frequência de conformidade de indicação da Terapia Nutricional Enteral, 10.) Frequência de aplicação de Avaliação Subjetiva Global (ASG) em pacientes em Terapia Nutricional. As opiniões dos especialistas entrevistados foram significantemente consistentes. Durante a fase 2, 96% dos especialistas informaram estar satisfeitos com os 10 IQTNs selecionados, e 100% manifestaram que esta seleção refletiu a mesma opinião anteriormente emitida,na primeira fase do estudo. CONCLUSÃO: A avaliação da opinião de especialistas em TN, com o uso de técnicas psicométricas e ferramentas estatísticas, possibilitou a identificação dedezIQTNsmais pontuados,com consistência e representatividade de opiniões entre eles.A redução do número de trinta e seis IQTNs para os dez presentemente identificados pode contribuir para sua aplicação clínica / BACKGROUND: Quality indicators in nutritional therapy (QINT) are central tools to evaluate and monitor the quality of nutritional therapy. In addition to the scarcity of human and material resources, the application of the QINT available for clinical practice in Brazil has been limited also due to its elevated number. This study attempted to identify the ten more scored QINT that suit in the clinical practice, among those available in Brazil, through evaluating experts in Nutritional Therapy (NT). METHODS: All the 36 available QINTs to the clinical application in Brazil were evaluated in two distinct phases. In the phase 1 (selection), 26 experts in NT rated the QINTs following four attributes (utility, simplicity, objectivity and low cost), on a 5- point Likert scale. The top 10 QINTs were identified from the top 10 scores; and the reliability of the experts opinion to each indicator were evaluated by Cronbachs alpha. In phase 2, the top 10 selected QINTs were subjected in a new experts analysis following two closed questions. RESULTS: The top 10 selected QINTs, from the biggest to the least scored order, were: 1) Frequency of carrying out nutrition screening of hospitalized patients, 2) Frequency of diarrhea in patients on Enteral Nutrition (EN), 3) Frequency of involuntary withdrawal of enteral feeding tubes, 4) Frequency of tube feeding occlusion in patients on EN, 5) Frequency of digestive fasting for more than 24 hours in patients on oral nutrition or EN, 6) Frequency of patients with glycemic dysfunction on NT, 7) Frequency of measurement or estimation of energy expenditure and protein needs in patients on NT, 8) Frequency of Central Venous Catheter infection in patients on Parenteral Nutrition, 9) Frequency of indication compliance of NT 10) Frequency of application of Subjective Global Assessment in patients on NT. The opinions of the experts interviewed were significantly consistent. During the phase 2, 96% of the experts were found to be satisfied with the top 10 selected QINTs, and 100% expressed that the selection of the top 10 QINTs interfered the same opinion in the first phase of the study. CONCLUSION: The evaluation of the experts opinion in NT using psychometrics techniques and statistical tools, allowed the identification of the 10 most scored QINTs, with good applicability in NT and representativeness of opinions among them. The reduction of QINT number from 36 to ten, may contribute to their clinical application

Author's title and name: Bc. Veronika Součková Institute: Charles University, Prague 1. Faculty of medicine Kateřinská 32, 121 08, Prague 2 Study branch: follow-up Master's - intensive care Study programme: specialization in intensive care Title: Nasojejunal tube placement techniques Consultant: MUDr. František Novák, Ph.D. Number of pages: 81 Number of attachments: 3 Number of tables, grafs and pictures: 24 Year of presentation: 2013 Keywords: Nasojejunal tube, placement techniques, enteral nutrition, endoscopy, fluoroscopy, blind bedside technique This dissertation is dedicated to the issue and options in the field of nasojejunal tubes placement technique. Theoretical part aims at the description of methods and procedures of placing the nasojejunal tube and briefly mentions possible complications and principles of enteral nutrition, which is administrated by this method. Empirical part of the dissertation aims at the comparison of placement the nasojejunal tube using the blind bedside technique developed at intensive care unit in General University Hospital in Prague to, endoscopic and fluoroscopic methods. The research brings description and comparison of the most frequently used methods of placement the feeding tube into the small intestine.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2006. / INTRODUCTION: The primary objective was to determine whether acidified formulae (pH 3.5 and 4.5) decreased gastric and tracheal colonisation, as well as microbial contamination of the enteral feeding delivery system, compared with a non-acidified control formula (pH 6.8) in critically ill patients. Secondary objectives included tolerance of the trial formulae and mortality in relation to the administration of acidified formulas. DESIGN: The trial was a controlled, double-blinded, randomised clinical trial of three parallel groups at a single centre. METHOD: Sixty-seven mechanically ventilated, medical and surgical critically ill patients were randomised according to their APACHE II scores and included in the trial. Patients received either an acidified (pH 3.5 or 4.5) or control polymeric enteral formula via an 8-Fr nasogastric tube at a continuous rate. Daily samples were taken for microbiologic analyses of the enteral formulae at various stages of reconstitution and at 6-hour and 24-hour intervals during administration thereof (feeding bottle and delivery set). Daily patient samples included nasogastric and tracheal aspirates, haematological evaluation and gastro-intestinal tolerance. The trial period terminated when patients were extubated, transferred from the ICU, enteral nutrition became contraindicated, a patient died, or for a maximum of 21 days. RESULTS: Gastric pH showed no significant difference (p = 0.86) between the 3 feeding groups [pH 3.5 (n = 23), pH 4.5 (n = 23) and pH 6.8 (n = 21)] at baseline prior to the administration of enteral formulae. After initiation of feeds, the gastric pH decreased significantly (p< 0.0001) in the acidified formulae as compared to the control formula during the trial period. Patients who received acidified enteral formulae (pH 3.5 and 4.5) had significantly less (p < 0.0001) contamination from the feeding bottles and delivery systems in respect of Enterobacteriacea, and Enterococcus., The more acidified group (pH 3.5) showed significantly less gastric contamination (p = 0.029) with Enterobacteriacea, , but not for fungi. The 3.5 acidified group also had the lowest gastric growth in terms of colony counts (≤104) of these organisms, but not for fungi, when compared to the control group (≤105). Vomiting episodes were 22% and abdominal distension 12%, with a higher incidence in the control group. Adverse events occurred equally between the groups with a higher, but not significantly different incidence of 37% in the control group and 32% for the acidified groups. There was no evidence of gastro-intestinal bleeding in any patient. Overall, the mortality rate in this trial was 6%, with 6.5% for the acidified groups (n=46) and 4.8% for the control group (n=21), a statistically insignificant difference. CONCLUSION: Acidified enteral formulae significantly decrease gastric colonisation by preserving gastric acidity that decreases the growth of Enterobacteriaceaes organisms. Acidified formulae significantly decrease bacterial contamination of the enteral feeding system (bottle and delivery set) of Enterobacteriaceae and Enterococcus organisms. Acidified formulae are tolerated well in critically ill patients.

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico. Programa de Pós -Graduação em Computação. / Made available in DSpace on 2012-10-18T04:28:03Z (GMT). No. of bitstreams: 0Bitstream added on 2014-09-26T00:45:10Z : No. of bitstreams: 1 182793.pdf: 11520486 bytes, checksum: 45abbbd434b7b3f79ac6a2bb317b17ba (MD5) / Este trabalho descreve a construção de sistemas baseados em conhecimento aplicados ao apoio a diagnóstico clínico utilizando sistemas especialistas probabilísticos. Desenvolveu-se um protótipo para apoio ao cálculo da dieta enteral, uma das formas de tratamento da desnutrição energético protéica infantil, que é uma das carências nutricionais de maior importância no país. Este sistema, denominado SANEP (Sistema de Apoio a Nutrição Enteral Pediátrica), é capaz de indicar e calcular a dieta enteral para crianças desnutridas até 2 anos de idade. A base de conhecimento do SANEP foi construída utilizando redes bayesianas, por meio da shell Netica, realizando o raciocínio inferencial por meio do Teorema de Bayes. Serão usuários do sistema médicos, nutricionistas e demais profissionais de um equipe de suporte nutricional, desta forma o SANEP foi desenvolvido no ambiente Delphi 5, que oferece uma interface agradável, e integrando-se a base de conhecimento através das DLL's da shell Netica. A avaliação qualitativa realizada junto a médicos pediatras, especialistas do domínio de conhecimento, verificou-se que o SANEP é de fácil utilização, apresentando resultados satisfatórios às diversas consultas realizadas. A avaliação quantitativa foi realizada gerando ruídos nas probabilidades condicionais da rede bayesiana, concluindo-se que esta permaneceu robusta para aumentos em até 40% nos menores valores de probabilidade. Com a implantação em maternidades e ambulatórios tem-se a possibilidade de utilização prática do SANEP, com a diminuição do tempo dispendido no cálculo manual da nutrição enteral, disponibilizando para os profissionais da equipe nutricional a oportunidade de preocupar-se mais com a fisiopatologia das doenças, com o diagnóstico e o atendimento da criança.

Acute pancreatitis is a disease which can present in a mild or severe form. In the last few years, the incidence of acute pancreatitis has been steadily rising. The treatment of severe cases is complex and nutrition is one of the key treatment factors. Enteral and parenteral nutrition are documented parts of acute phase treatment included in many guidelines. However, there is a controversy about the timing of initiation of peroral nutrition after the acute phase of severe pancreatitis has resolved. This dissertation shows the results of monocentric prospective randomized trial which compares the safety and effectivity of peroral nutrition compared to enteral nutrition in patients with severe acute pancreatitis during hospitalization as well as in long term after hospital discharge. Patients with severe acute pancreatitis were randomized into two groups - enteral nutrition versus peroral nutrition. The randomized nutrition strategy was initiated within the first 14 days of hospitalization. We monitored the length of hospital stay, tolerance of nutrition, complications, body weight and nutrition parameters. The two groups did not differ significantly in the length of hospital stay. The number of complications was similar between the groups, there was no significant difference in the rate of acute...

This diploma thesis deals with the topic of nutritional support in patients with neurological diseases (stroke and Critical-Illness-Polyneuropathy). The aim of this thesis is to find out, how implemented unified system of nutritional support affects the well-being of patients at neuro-rehabilitation clinic Asklepios Schlossberg Klinik in Bad König. There were observed 55 patients (30 men and 25 women) for 8 weeks. The theoretical part of this thesis describes basic components of nutrition, energy expenditure and needs, selected neurological diseases, dysphagia, malnutrition. The emphasis is put on nutrition in intensive neurological care. The practical part of the thesis analyses data obtained by the observation. There are observed changes of body weight, BMI and laboratory values of total protein, albumin and glycaemia in serum. These data are divided by sex, age, type of disease and initial BMI values. The observed patients had mainly overweight and obesity, which have lost a part of their excess weight due to catabolism. At the beginning of the observation 13 patient had normal BMI value, this number of patients rose to 24 after eight weeks. At the end of the observation the reduction of BMI value was on the average 2.45 units. Based on the results, it was found that although patients due to...

La nutrición enteral temprana se recomienda en pacientes adultos críticamente enfermos. Esta administración continua de nutrición enteral en pacientes críticos sigue siendo la práctica más común en todo el mundo; sin embargo, su práctica se ha cuestionado recientemente en favor de la administración de nutrición enteral intermitente, donde el volumen se infunde varias veces al día. Es por ello que se formula la pregunta clínica: ¿Cuáles son las evidencias de la nutrición enteral continua vs nutrición enteral intermitente en pacientes de cuidados intensivos?, la investigación empleará la metodología EBE, se eligieron las palabras claves según el MESH / DECS, teniendo como criterios de inclusión: Pacientes adultos críticos que estén en la unidad de cuidados intensivos. Y los criterios de exclusión: Pacientes pediátricos, Gestantes. Inmediatamente se procedió a investigar en las bases de datos: Pubmed, Epistemonikos, Sciencedirect, Google Académico y BVS; obteniendo 10 artículos de investigación; llegando a seleccionar los 10 artículos; los cuales fueron aprobados a través de la Guía de Validez y utilidad propuesto por Gálvez Toro. Para el análisis de comentario crítico se utilizó la lista de chequeo de CASPE- REV SISTEMATICA. En la respuesta a la pregunta clínica, el gran impacto de esta nutrición intermitente es la efectividad que tiene y la probabilidad de alcanzar el objetivo calórico, así mismo disminuye la invidencia de la broncoaspiración y la introducción de microorganismos patógenos al manipular los dispositivos de la alimentación, preparación y almacenamiento. Se identificó al nivel de evidencia según Scottish Intercollegiate Guidelines Network (SIGN) 1+ y grado de recomendación Moderada.

Mechanically ventilated critically ill patients treated in the intensive care unit (ICU) require enteral feedings to maintain adequate nutrition during critical illness. Delivery of adequate enteral nutrition is also critical to the recovery of critically ill patients. Enteral nutrition has been shown to decrease length of time on the ventilator, decrease length of stay and ICU and decrease mortality. Despite all the evidence regarding the benefits of enteral nutrition, critically ill patients continue to receive less than their prescribed calories and protein. Nurses are in a unique position to influence the delivery of enteral nutrition. Nursing practices that contribute to underfeeding must be identified and corrected to ensure adequate delivery of nutrients is achieved. The purpose of the study was to describe the professional practice of critical care nurses regarding enteral feeding in mechanically ventilated critically ill patients. Several barriers were identified by the participants in the study that contributed to underfeeding including inconsistent practice regarding gastric residual volume, holding feeds when changing patient position and lack of a standardized protocol for enteral feeding. Also identified in the study was the idea that nurses do not see enteral feeding as a life-saving intervention. It is not the “sexy part” of what ICU nurses do. Enteral feeding guidelines need to be developed to include those interventions that are important to nursing practice in order to increase enteral feeding times and improve patient outcomes.

Acute pancreatitis is a disease which can present in a mild or severe form. In the last few years, the incidence of acute pancreatitis has been steadily rising. The treatment of severe cases is complex and nutrition is one of the key treatment factors. Enteral and parenteral nutrition are documented parts of acute phase treatment included in many guidelines. However, there is a controversy about the timing of initiation of peroral nutrition after the acute phase of severe pancreatitis has resolved. This dissertation shows the results of monocentric prospective randomized trial which compares the safety and effectivity of peroral nutrition compared to enteral nutrition in patients with severe acute pancreatitis during hospitalization as well as in long term after hospital discharge. Patients with severe acute pancreatitis were randomized into two groups - enteral nutrition versus peroral nutrition. The randomized nutrition strategy was initiated within the first 14 days of hospitalization. We monitored the length of hospital stay, tolerance of nutrition, complications, body weight and nutrition parameters. The two groups did not differ significantly in the length of hospital stay. The number of complications was similar between the groups, there was no significant difference in the rate of acute...