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1.
Rev. Inst. Adolfo Lutz (Online) ; 83: 39226, 30 jan. 2024. tab
Article in English | LILACS, CONASS, ColecionaSUS, SES-SP, SESSP-ACVSES, SESSP-IALPROD, SES-SP, SESSP-IALACERVO | ID: biblio-1555105

ABSTRACT

To know the profile of food and enteral formulation handlers is important to promote more effective health education actions for these individuals. This study aimed to develop instruments to evaluate the profile of food handlers in households (PFH) and in food service establishments (PFSE), as well as the profile of handlers of enteral formulations in households (PEFHH). A scoping review was carried out to identify questions about the profile of food and enteral formulation handlers evaluated in studies in thein the main national and international databases. From 47 selected articles, 66 questions were identified. Of these, 17, 22, and 18 questions were established to assess the PFH, PFSE, and PEFHH, respectively. The instrument questions were subdivided by subject into personal data, sociodemographic and professional characteristics, and general information. Some questions differ between instruments due to segment specificities. The proposed instruments are novel tools. Through a scoping review and expert consultations, a comprehensive set of questions was identified and organized into instruments tailored to each specific segment. These tools will be valuable for nutritionists, researchers, and other professionals involved in assessing and addressing the needs of food handlers. (AU)


Conhecer o perfil do manipulador de alimentos e de formulações enterais é importante para promover ações de educação sanitária mais efetiva para esses indivíduos. Este estudo teve como objetivo elaborar instrumentos para avaliação do perfil do manipulador de alimentos em domicílios (PFH), em serviço de alimentação (PFSE) e de formulações enterais em domicílios (PEFHH). Realizou-se uma revisão de literatura do tipo Scoping review para identificar as questões sobre o perfil do manipulador de alimentos e de formulações enterais avaliadas nos estudos nas principais bases de dados nacionais e internacionais. A partir de 47 artigos selecionados, foram identificadas 66 questões. Destas, foram estabelecidas 17, 22 e 18 questões para avaliar o PFH, PFSE e PEFHH, respectivamente. As questões dos instrumentos foram subdivididas por assunto nas seguintes categorias: dados pessoais; características sociodemográficas e profissionais; e informações gerais. Algumas questões se diferenciam entre os instrumentos devido à particularidade de cada segmento. Os instrumentos propostos são ferramentas inovadoras. Através de uma revisão abrangente e consultas com especialistas, um conjunto abrangente de perguntas foi identificado e organizado em instrumentos adaptados a cada segmento específico. Essas ferramentas serão valiosas para nutricionistas, pesquisadores e outros profissionais envolvidos na avaliação e atendimento das necessidades dos manipuladores de alimentos. (AU)


Subject(s)
Enteral Nutrition , Food Handling , Food Services , Home Nursing
2.
Rev. cienc. cuidad ; 21(1): 95-104, 2024.
Article in Spanish | LILACS, BDENF, COLNAL | ID: biblio-1553652

ABSTRACT

La pancreatitis aguda es una patología cuyo manejo primario abarca medidas con el fin de asegurar el reposo gastrointestinal, la presente revisión sistemática tiene como fin valorar los beneficios obtenidos tras iniciarse una dieta oral inmediata en pacientes con pancreatitis aguda. Se realizó una revisión sistemática, bajo lineamentos PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), que incluyó ensayos clínicos controlados aleatoriza-dos, la búsqueda fue realizada en PubMed, ScienceDirect y Cochrane, se usaron los términos de búsqueda: "Acute pancreatitis", "Enteral nutrition" "Oral refeed" y "randomized controlado trial", obteniendo 393 artículos. Tras aplicar criterios de inclusión y exclusión, un total de 6 estudios se incluyeron en la revisión, se valoró: complicaciones o eventos adversos, gravedad del cuadro, requerimiento de analgesia, estancia hospitalaria, tolerancia a la dieta y gastos gene-rados, encontrando beneficios estadísticamente significativos, sobre todo en los últimos tres as-pectos. Se concluyó que la alimentación oral inmediata es segura en pacientes con pancreatitis aguda, pese a ello, es imprescindible generar más estudios multicéntricos con el fin de generar evidencia de mayor peso


Acute pancreatitis is a pathology whose primary management includes measures to ensure gastrointestinal rest. The present systematic review aims to assess the benefits obtained af-ter initiating an immediate oral diet in patients with acute pancreatitis. A systematic review was carried out, under PRISMA (Preferred Reporting Items for Systematic reviews and Me-ta-Analyses) guidelines, which included randomized controlled clinical trials, the search was performed in PubMed, ScienceDirect and Cochrane, using the search terms: "Acute pancre-atitis", "Enteral nutrition" "Oral refeed" and "randomized controlled trial", obtaining 393 articles. After applying inclusion and exclusion criteria, a total of 6 studies were included in the review, evaluating: complications or adverse events, severity of the condition, analgesia requirement, hospital stay, tolerance to the diet and expenses generated, finding statistically significant benefits, especially in the last three aspects. It was concluded that immediate oral feeding is safe in patients with acute pancreatitis; nevertheless, it is essential to generate more multicenter studies in order to generate more weighty evidence


A pancreatite aguda é uma patologia cuja gestão primária inclui medidas para assegurar o re-pouso gastrointestinal. Esta revisão sistemática visa avaliar os benefícios obtidos após o início de uma dieta oral imediata em doentes com pancreatite aguda. Foi realizada uma revisão sis-temática segundo as directrizes do PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses),, incluindo ensaios clínicos controlados aleatórios, a pesquisa foi realizada no PubMed, ScienceDirect e Cochrane, utilizando os termos de pesquisa: "Pancreatite aguda", "Nutrição enteral", "Refeição oral" e "ensaio controlado aleatório", obtendo 393 artigos. Após a aplicação dos critérios de inclusão e exclusão, foi incluído um total de 6 estudos na revisão, avaliando: complicações ou eventos adversos, gravidade da condição, necessidade de analgesia, internamento hospitalar, tolerância à dieta e custos gerados, encontrando benefícios estatisti-camente significativos, especialmente nos três últimos aspectos. A alimentação oral imediata é segura em doentes com pancreatite aguda, no entanto, é essencial gerar mais estudos multicên-tricos a fim de gerar provas mais significativas


Subject(s)
Early Medical Intervention , Pancreatitis , Enteral Nutrition , Diet
3.
J. nurs. health ; 13(3): 1332336, dez. 2023.
Article in Portuguese | LILACS, BDENF | ID: biblio-1538099

ABSTRACT

Objetivo: construir e validar um vídeo educativo para o manejo de terapia de nutrição enteral em unidade de terapia intensiva adulto. Método: estudo quantitativo aplicado, dividido em duas etapas principais: construção do vídeo, seguindo o referencial para criação de vídeo e, validação por concordância de nove juízes. Resultados: o índice de validade de conteúdo geral do estudo foi de 0,96, porém de todos os itens analisados três apresentaram índice de 0,77 e dois de 0,88. Conclusão: o vídeo validado é relevante e cumpre o objetivo a que se destina. Adiciona-se que, por partir de um pacote de medidas previamente implementado, dificulta a aplicação em todas as realidades.


Objective: to develop and validate an educational video for the management of enteral nutrition therapy in the adult intensive care unit. Method:this is a quantitative applied study, divided into two main stages: construction of the video, following the framework of video creationand validation by agreement of nine judges. Results:the study's overall content validity index was 0.96, but of all the items analyzed, three had an index of 0.77 and two of 0.88. Conclusion:the validated video is relevant and fulfills its purpose. In addition, because it is based on a package of measures that has been previously implemented, it is difficult to apply in all situations.


Objetivo:construiry validar un vídeo educativo para el manejo de la terapia nutricional enteral en la unidad de cuidados intensivos paraadultos. Método:se trata de un estudio cuantitativo aplicado, dividido en dos etapas principales: construcción del vídeo, siguiendo el marco de construir videosy validación por acuerdo de nueve jueces. Resultados:el índice global de validez de contenido del estudio fue de 0,96, pero de todos los ítems analizados, tres tuvieron un índice de 0,77 y dos de 0,88. Conclusión:el vídeo validado es pertinente y cumple su propósito. Además, al estar basado en un paquete de medidas previamente implementado, es difícil de aplicar en todas las realidades.


Subject(s)
Enteral Nutrition , Nursing , Educational Technology , Critical Care , Education, Continuing
4.
Distúrbios Comun. (Online) ; 35(4): e60491, 31/12/2023.
Article in English, Portuguese | LILACS | ID: biblio-1552923

ABSTRACT

Introdução: O câncer de cavidade oral constitui lesões da superfície da mucosa oral, e, devido às sequelas da doença e de seu tratamento, frequentemente ocorrem quadros de disfagia. Quando a alimentação por via oral se torna impossibilitada, é fundamental a indicação de vias alternativas de alimentação. Objetivo: verificar a ocorrência e os fatores associados ao uso de via alternativa de alimentação após câncer de língua. Método: A busca foi conduzida por dois pesquisadores independentes nas bases de dados Medline (Pubmed), LILACS, SciELO, Scopus, WEB OF SCIENCE e BIREME sem restrição de idioma e localização, no período de 2010 a 2021. Para complementar e evitar viés de risco foi realizada uma busca por literatura cinza no Google Scholar. Critérios de Seleção: A revisão sistemática foi conduzida conforme as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Foram incluídos na pesquisa estudos que obtiveram pontuação ≥ a 6 pontos segundo o protocolo para pontuação qualitativa proposto por Pithon. Resultados: Os estudos mostram que a maioria dos indivíduos com câncer oral desenvolvem uma perda significativa de peso, necessitando de intervenção. O estágio geral da doença é um preditor significativo de perda de peso crítica em pacientes em tratamento. Conclusão: A indicação de via alternativa de alimentação após câncer de língua foi de 19,3% a 68,2%, e os fatores associados a essa indicação de VAA foram o estágio geral, cirurgia associada à terapia adjuvante, má adesão ao tratamento multidisciplinar, presença de complicações e baixa sobrevida. (AU)


Introduction: Oral cavity cancer constitutes lesions on the surface of the oral mucosa and, due to the consequences of the disease and its treatment, dysphagia often occurs. When oral feeding becomes impossible, it is essential to indicate alternative feeding routes. Objective: to verify the occurrence and factors associated with the use of an alternative feeding route after tongue cancer. Method: The search was conducted by two independent researchers in the Medline (Pubmed), LILACS, SciELO, Scopus, WEB OF SCIENCE and BIREME databases without language and location restrictions, from 2010 to 2021. To complement and to avoid risk bias, a search for gray literature on Google Scholar was performed. Selection Criteria: The systematic review was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies that scored ≥ 6 points according to the protocol for qualitative scoring proposed by Pithon. Results: Studies show that most individuals with oral cancer develop significant weight loss, requiring intervention. The overall stage of the disease is a significant predictor of critical weight loss in patients undergoing treatment. Conclusion: The indication of an alternative feeding route after tongue cancer was 19.3% to 68.2%, and the factors associated with this indication of AAV were the general stage, surgery associated with adjuvant therapy, poor adherence to multidisciplinary treatment, presence of complications and poor survival. (AU)


Introducción: El cáncer de cavidad oral constituye lesiones en la superficie de la mucosa oral y, debido a las consecuencias de la enfermedad y su tratamiento, es frecuente que se presente disfagia. Cuando la alimentación oral se hace imposible, es imprescindible la indicación de vías alternativas de alimentación. Objetivo: verificar la ocurrencia y los factores asociados al uso de una vía alternativa de alimentación después del cáncer de lengua. Método: La búsqueda fue realizada por dos investigadores independientes en las bases de datos Medline (Pubmed), LILACS, SciELO, Scopus, WEB OF SCIENCE y BIREME, sin restricciones de idioma y ubicación, de 2010 a 2021. Para complementar y Evitar riesgo de sesgo, se realizó una búsqueda de literatura gris en Google Scholar. Criterios de selección: La revisión sistemática se llevó a cabo de acuerdo con las recomendaciones de Elementos de informe preferidos para revisiones sistemáticas y metanálisis (PRISMA). Los estudios que puntuaron ≥ 6 puntos según el protocolo de puntuación cualitativa propuesto por Pithon et al. (2015). Resultados: Los estudios muestran que la mayoría de las personas con cáncer oral desarrollan una pérdida de peso significativa, lo que requiere intervención. El estadio general de la enfermedad es un predictor significativo de pérdida de peso crítica en pacientes que reciben tratamiento. Conclusión: La indicación de vía alternativa de alimentación tras cáncer de lengua varió del 19,3% al 68,2%, y los factores asociados a esta indicación de AAV fueron el estadio general, cirugía asociada a terapia adyuvante, mala adherencia al tratamiento multidisciplinario, presencia de complicaciones y baja supervivencia. (AU)


Subject(s)
Humans , Tongue Neoplasms/complications , Enteral Nutrition , Feeding Methods , Weight Loss , Deglutition Disorders/etiology , Deglutition Disorders/therapy , Nutritional Status
5.
Distúrbios Comun. (Online) ; 35(4): e61762, 31/12/2023.
Article in English, Portuguese | LILACS | ID: biblio-1552982

ABSTRACT

Introdução: O momento para introdução de alimentação via oral plena em neonatos é desafiador. Protocolos auxiliam nesse processo utilizando majoritariamente avaliações subjetivas, porém, estudos apontam a importância de incluir critérios objetivos. Objetivo: Analisar a visão da equipe de Fonoaudiologia sobre utilização de protocolos e construção de raciocínio clínico na introdução via oral em uma unidade neonatal. Método: Pesquisa qualitativa, analítica, exploratória. Coleta de dados por meio de grupos focais e por questionário de perfil sociodemográfico e técnico-científico dos participantes. Resultados: Participaram três preceptoras e três residentes entre 25 e 39 anos, de diferentes etnias, formadas entre um e 16 anos, de dois a 12 anos atuando em Neonatologia. Possuem aprimoramentos, cursos e três realizaram especialização. Emergiram dos grupos focais cinco categorias de análise: formação especializada como reflexo das necessidades de saúde da população; processo de construção da competência para assistência em neonatologia baseado nas diretrizes da Iniciativa Hospital Amigo da Criança; alinhamento das condutas da equipe e melhor acompanhamento da evolução dos casos; dificuldade na aplicação do protocolo no processo de trabalho; e, sugestões de incrementos ao protocolo baseados em diretrizes institucionais. Conclusão: A equipe utiliza protocolo institucional embasado na literatura, ao qual se sugere adicionar critérios objetivos para melhores resultados assistenciais e aprimorar o processo de ensino- aprendizagem das residentes. (AU)


Introduction: Identifying the moment to introduce full oral administration in neonates is challenging. Protocols assist in this process using mostly subjective assessments; however, studies demonstrate the importance of including objective criteria. Objective: To analyze the view of the Speech Therapy team on the use of protocols and construction of clinical reasoning in oral introduction in a neonatal unit. Method: Qualitative, analytical, exploratory research. Data collection through focus groups and a socio-demographic and technical-scientific profile questionnaire of the participants. Results: Three preceptors and three residents between 25 and 39 years old, of different ethnicities, graduated between one and 16 years, from two to 12 years working in Neonatology, participated. They have improvements, courses and three completed postgraduate studies. Five categories of analysis emerged from the focus groups: specialized training as a reflection of the population's health needs; competence building process for assistance in neonatology based on the guidelines of the Baby-Friendly Hospital Initiative; alignment of the team's conduct and better monitoring of the evolution of cases; difficulty in applying the protocol in the work process; and suggestions for increments to the protocol based on institutional guidelines. Conclusion: The team uses an institutional protocol based on the literature. It is suggested to add objective criteria for better results, helping residents to learn. (AU)


Introducción: el momento de introducir la administración oral completa en neonatos es un desafío. Los protocolos ayudan en este proceso utilizando evaluaciones mayoritariamente subjetivas, sin embargo, los estudios señalan la importancia de incluir criterios objetivos. Objetivo: Analizar la visión del equipo de Fonoaudiología sobre el uso de protocolos y construcción del razonamiento clínico en la introducción oral en una unidad neonatal. Método: Investigación cualitativa, analítica, exploratoria. Recopilación de datos a través de grupos focales y cuestionario de perfil sociodemográfico y técnico-científico de los participantes. Resultados: Participaron tres preceptores y tres residentes entre 25 y 39 años, de diferentes etnias, egresados entre uno y 16 años, de dos a 12 años trabajando en Neonatología. Cuentan con mejoras, cursos y tres estudios de posgrado terminados. De los grupos focales surgieron cinco categorías de análisis: la formación especializada como reflejo de las necesidades de salud de la población; proceso de construcción de competencias para la asistencia en neonatología a partir de los lineamientos de la Iniciativa Hospital Amigo del Ninõ; alineación de la conducta del equipo y mejor seguimiento de la evolución de los casos; dificultad en la aplicación del protocolo en el proceso de trabajo; y, sugerencias para incrementos al protocolo basados en lineamientos institucionales. Conclusión: : El equipo utiliza un protocolo institucional basado en la literatura, al que se sugiere agregar criterios objetivos para mejores resultados de atención y mejorar el proceso de enseñanza-aprendizaje de los residentes. (AU)


Subject(s)
Humans , Female , Adult , Health Knowledge, Attitudes, Practice , Enteral Nutrition , Guidelines as Topic , Speech, Language and Hearing Sciences , Clinical Reasoning , Intensive Care Units, Neonatal , Health Personnel , Qualitative Research
6.
Distúrbios Comun. (Online) ; 35(4): e62197, 31/12/2023.
Article in English, Portuguese | LILACS | ID: biblio-1553338

ABSTRACT

Introdução: A avaliação fonoaudiológica hospitalar tem um importante papel na prevenção e manejo de pacientes com risco de broncoaspiração. No entanto, nem sempre cabe ao fonoaudiólogo a primeira avaliação e definição da via alimentar nos pacientes hospitalares. Objetivo: Comparar as decisões fonoaudiológicas e médicas quanto à viabilidade da via alimentar em um hospital geral e identificar fatores associados com a melhora da deglutição. Métodos: Trata-se de um estudo retrospectivo de pacientes internados em hospital em Joinville durante março a agosto de 2018. A via alimentar foi considerada com base na Functional Oral Intake Scale (FOIS) sendo a primeira decisão comparada entre o fonoaudiólogo e o médico para o mesmo paciente. Resultados: Dos 171 pacientes, houve maior concordância entre as condutas médica e fonoaudiológica para alimentação por sonda nasoenteral (SNE) (88,7%) e alimentação oral livre (81,9%). No entanto, houve apenas 35% de concordância na definição de dieta adaptada, sendo a concordância geral moderada (Kappa 0,486). Houve evolução na alimentação por via oral em 62 pacientes (36%). Maior limitação da via alimentar, verificado pela necessidade de SNE (OR = 3,17; p = 0,025) e o maior número de atendimentos fonoaudiológicos intra-hospitalares (OR = 1,09; p = 0,020) foram associados com a melhora da disfagia. Conclusão: Encontrou-se concordância entre a avaliação dietética de casos para uso de SNE ou dieta livre entre o fonoaudiólogo e médico. Uso de SNE, como indicador de gravidade do paciente, e o maior número de sessões de fonoterapia foram associados com a melhora da disfagia durante a internação. (AU)


Introduction: Hospital-based speech-language pathology plays a crucial role in preventing and managing patients at risk of bronchoaspiration. However, the initial evaluation and determination of the feeding route in hospitalized patients may not always fall under the responsibility of the speech-language pathologist. Objective: To compare the decisions of speech-language pathologists and medical professionals regarding the feasibility of the feeding route in a general hospital and identify factors associated with swallowing improvement. Methods: This is a retrospective study of patients admitted to a hospital in Joinville from March to August 2018. The feeding route was assessed based on the Functional Oral Intake Scale (FOIS), with the initial decision compared between the speech-language pathologist and the physician for the same patient. Results: Among 171 patients, there was higher agreement between medical and speech-language pathology decisions for nasoenteral tube feeding (88.7%) and oral unrestricted intake (81.9%). However, there was only 35% agreement in defining an adapted diet, with overall moderate agreement (Kappa 0.486). Oral feeding improved in 62 patients (36%). The presence of nasoenteral tube feeding (OR = 3.17; p = 0.025) and a higher number of in-hospital speech-language pathology appointments (OR = 1.09; p = 0.020) were identified as independent predictors for dysphagia improvement. Conclusion: Concordance was found in the dietary assessment for the use of nasoenteral tube feeding or oral unrestricted intake between speech-language pathologists and physicians. The use of nasoenteral tube feeding as an indicator of patient severity and a higher number of speech-language pathology sessions were associated with dysphagia improvement during hospitalization. (AU)


Introducción: La evaluación fonoaudiológica hospitalaria desempeña un papel crucial en la prevención y el manejo de pacientes con riesgo de broncoaspiración. Sin embargo, no siempre corresponde al fonoaudiólogo la primera evaluación y definición de la vía alimentaria en los pacientes hospitalizados.Objetivo: Comparar las decisiones fonoaudiológicas y médicas sobre la viabilidad de la vía alimentaria en un hospital general e identificar factores asociados con la mejora de la deglución. Métodos: Se trata de un estudio retrospectivo de pacientes hospitalizados en un hospital de Joinville durante marzo a agosto de 2018. La vía alimentaria se evaluó según la Escala Funcional de Ingesta Oral (FOIS), siendo la primera decisión comparada entre el fonoaudiólogo y el médico para el mismo paciente. Resultados: De 171 pacientes, hubo una mayor concordancia entre las decisiones médicas y fonoaudiológicas para la alimentación por sonda nasoenteral (SNE) (88,7%) y la alimentación oral libre (81,9%). Sin embargo, solo hubo un 35% de concordancia en la definición de una dieta adaptada, siendo la concordancia general moderada (Kappa 0,486). La alimentación oral mejoró en 62 pacientes (36%). Una mayor limitación de la vía alimentaria, indicada por la necesidad de SNE (OR = 3,17; p = 0,025), y un mayor número de sesiones fonoaudiológicas intrahospitalarias (OR = 1,09; p = 0,020) se asociaron con la mejora de la disfagia.Conclusión: Se encontró concordancia en la evaluación dietética para el uso de SNE o dieta libre entre el fonoaudiólogo y el médico. El uso de SNE, como indicador de la gravedad del paciente, y un mayornúmero de sesiones de fonoterapia se asociaron con la mejora de la disfagia durante la hospitalización. (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Deglutition Disorders/rehabilitation , Enteral Nutrition , Physicians , Clinical Evolution , Retrospective Studies , Cohort Studies , Speech, Language and Hearing Sciences , Hospitalization , Interprofessional Relations
7.
Ludovica pediátr ; 26(2): 28-38, dic.2023.
Article in Spanish | LILACS | ID: biblio-1531133

ABSTRACT

La malnutrición en los pacientes hospitalizados representa un importante problema sanitario asociado a una mayor tasa de complicaciones con un incremento de la morbimortalidad


Malnutrition in hospitalized patients represents a significant health problem associated with an increased rate of complications and higher morbidity and mortality


Subject(s)
Child, Hospitalized , Enteral Nutrition , Malnutrition , Child , Nutritional Status , Protein-Energy Malnutrition
8.
Rev. latinoam. enferm. (Online) ; 31: e3888, ene.-dic. 2023. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1431834

ABSTRACT

Abstract Objective: to evaluate how different educational strategies contribute to knowledge gains perceived by caregivers of people using Enteral Nutritional Therapy. Method: a quasi-experimental study conducted in two stages: the first one included an interactive lecture class (LC) and the second was carried out in two groups: in-situ simulated skills training (ST) and reading of an educational booklet (EB). The caregivers answered a self-administered questionnaire to assess knowledge before and after the interventions; for the analysis, a generalized linear model with Poisson distribution was proposed and the comparisons were carried out using orthogonal contrasts. Results: the participants were 30 caregivers; evidence of a difference in knowledge between the t1and t0 moments is evidenced. The analysis of the final comparison about the knowledge gain between the EB and ST groups, according to Student's t, evidenced an estimated difference of -1,33, with 95% CI (-4.98; 2.31) and p-value=0.46. Conclusion: knowledge was further increased between the t1 and t0 moments, when compared to the t2 and t1 moments in both groups. When compared, we cannot conclude that one of the groups changed more than the other in relation to moment t0 and t2; thus, the study evidenced the knowledge gain after all the educational strategies in both groups.


Resumo Objetivo: avaliar como diferentes estratégias educativas contribuem para ganhos de conhecimento percebidos por cuidadores de pessoas em uso da Terapia Nutricional Enteral. Método: estudo quase-experimental realizado em duas etapas; a primeira contemplou uma aula expositiva dialogada (AE) e a segunda aconteceu em dois grupos: treino de habilidades (TH) simulado in situ e leitura da cartilha educativa (CE). Os cuidadores responderam um questionário autoaplicável para avaliação de conhecimentos em pré e pós-intervenções; para a análise foi proposto um modelo linear generalizado com distribuição Poisson e as comparações foram realizadas por contrastes ortogonais. Resultados: participaram 30 cuidadores, observou-se evidência de diferença de conhecimento entre os tempos t1 e t0. A análise da comparação final sobre o aumento do conhecimento entre os grupos CE e TH, por teste t-Student, evidenciou uma diferença estimada de -1,33, com IC 95% (-4,98; 2,31) e valor de p de 0,46. Conclusão: ocorreu uma maior elevação de conhecimento entre os tempos t1 e t0, quando comparada os tempos t2 e t1 em ambos os grupos. Quando comparados, não podemos concluir que um dos grupos mudou mais que o outro em relação aos tempos t0 e t2; assim, o estudo evidenciou o ganho de conhecimento após todas as estratégias educativas nos dois grupos.


Resumen Objetivo: evaluar cómo las diferentes estrategias educativas contribuyen a la adquisición de conocimiento percibida por los cuidadores de personas que utilizan Terapia Nutricional Enteral. Método: estudio cuasiexperimental realizado en dos etapas; la primera incluyó una clase expositiva dialogada (CE) y la segunda se desarrolló en dos grupos: entrenamiento de habilidades (EH) simuladas in situ y lectura del folleto educativo (FE). Los cuidadores respondieron un cuestionario autoadministrado para evaluar el conocimiento pre-posintervenciones; para el análisis se propuso un modelo lineal generalizado con distribución de Poisson y las comparaciones se realizaron mediante contrastes ortogonales. Resultados: participaron 30 cuidadores, había evidencias de la diferencia de conocimiento entre los tiempos t1 y t0. El análisis de la comparación final sobre el aumento de conocimientos entre los grupos FE y EH, mediante la prueba t de Student, mostró una diferencia estimada de -1,33, con un IC del 95% (-4,98; 2,31) y un valor de p de 0,46. Conclusión: hubo un mayor aumento del conocimiento entre los tiempos t1 y t0, que entre los tiempos t2 y t1 en ambos grupos. Al compararlos, no podemos concluir que uno de los grupos cambió más que el otro entre t0 y t2; por lo tanto, el estudio demostró que hubo adquisición de conocimiento después de todas las estrategias educativas en ambos grupos.


Subject(s)
Humans , Students , Health Education , Caregivers/education , Enteral Nutrition , Simulation Training
9.
Distúrb. comun ; 35(3): 62265, 25/10/2023.
Article in English, Portuguese | LILACS | ID: biblio-1526069

ABSTRACT

Introdução: A retirada da sonda no recém-nascido pré-termo (RNPT) e o adequado estabelecimento da via oral são importantes para a saúde do bebê, já que favorecem aleitamento materno e alta hospitalar, entretanto, é um desafio nas unidades neonatais. Objetivos: Analisar os fatores associados ao tempo de transição da sonda para via oral em RNPT internados em Unidade Neonatal do Sistema Único de Saúde (SUS). Método: Foi realizado um estudo observacional analítico de coorte, com 45 RNPT que usaram sonda para alimentação no período de dezembro de 2021 a janeiro de 2022 e foram acompanhados pela equipe de Fonoaudiologia do serviço. Foram avaliados: a prontidão do prematuro para alimentação oral; a via oral com a técnica do finger feeding; a mamada e os níveis de habilidade oral. Resultados: Estiveram relacionadas ao maior tempo para transição da sonda para a via oral a idade gestacional ao nascimento inferior a 32 semanas, o peso ao nascimento inferior a 1500 gramas, a ausência de prontidão para via oral e a alta hospitalar em aleitamento artificial. Conclusão: Características do RNPT e da alimentação na avaliação e na alta hospitalar foram associados ao menor tempo de transição da sonda para a via oral. Assim, intervenções que estimulem o alcance da via oral no período de internação podem contribuir para a redução do tempo de transição e para o estímulo do aleitamento materno, favorecendo a saúde do RN, o vínculo mãe-bebê, a alta precoce, propiciando a rotatividade de leitos e, consequentemente, maior oferta aos usuários do SUS. (AU)


Introduction: The removal of the feeding tube in premature infants and the successful establishment of oral feeding are important for the baby's health, as they promote breastfeeding and hospital discharge. However, it is a challenge in neonatal units. Objectives: This article analyzes the factors associated with the time of transition from tube feeding to oral feeding in premature infants admitted to the Neonatal Unit of the Brazilian Unified Health System (SUS). Method: An analytical observational cohort study was conducted with 45 premature infants who used a feeding tube from December 2021 to January 2022 and were accompanied by the Speech Therapy team of the service. The following factors were evaluated: premature infant's readiness for oral feeding, oral feeding with finger feeding technique, breastfeeding, and levels of oral skill. Results: Factors associated with a longer transition time from tube feeding to oral feeding included gestational age at birth of fewer than 32 weeks, birth weight under 1500 grams, lack of readiness for oral feeding, and hospital discharge with artificial feeding. Conclusion: Characteristics of the premature infant and feeding at assessment and hospital discharge were associated with a shorter transition time from the tube to oral feeding. Therefore, interventions that stimulate oral feeding during hospitalization can help reduce the transition time and promote breastfeeding, benefiting the health of premature infants and the mother-baby bond. They can also contribute to early discharge, allowing for bed turnover and, consequently, increased availability for SUS users. (AU)


Introducción: La retirada de la sonda en los prematuros y el establecimiento adecuado de la vía bucal son importantes para la salud del bebé, ya que favorecen la lactancia y el alta hospitalaria, sin embargo, es un desafío en las unidades neonatales. Objetivos: Este artículo analiza los factores asociados al tiempo de transición de la sonda a la vía oral en prematuros internados en la Unidad Neonatal del Sistema Único de Salud (SUS). Método: Se realizó un estudio observacional analítico de cohortes, con 45 prematuros que utilizaron sonda de alimentación desde diciembre de 2021 hasta enero de 2022 y fueron seguidos por el equipo de logopedia del servicio. Se evaluaron: la disposición del prematuro para la alimentación oral; la vía oral con la técnica de alimentación con los dedos; lactancia materna y niveles de habilidad oral. Resultados: La edad gestacional ao nacer de menos de 32 semanas, el peso de nacimiento de menos de 1500 gramos, la falta de preparación para la administración oral y el alta hospitalaria con alimentación artificial se relacionaron con el mayor tiempo de transición de la vía por sonda a la vía oral. Conclusión: Las características del recién nacido prematuro y la alimentación en el momento de la evaluación y el alta hospitalaria se asociaron con un menor tiempo de transición de la sonda a la vía oral. Así, las intervenciones que fomenten la vía oral durante el período de hospitalización pueden contribuir a reducir el tiempo de transición y fomentar la lactancia materna, favoreciendo la salud del prematuro y el vínculo madre-bebé, además de contribuir al alta precoz, promoviendo la rotación de enfermeras, camas y, en consecuencia, mayor oferta a los usuarios del SUS. (AU)


Subject(s)
Humans , Infant, Newborn , Infant, Premature , Enteral Nutrition , Feeding Methods , Unified Health System , Intensive Care Units, Neonatal , Longitudinal Studies
10.
Distúrb. comun ; 35(1): e58948, 01/06/2023.
Article in Portuguese | LILACS | ID: biblio-1436184

ABSTRACT

Introdução: A prematuridade é um fator de risco para o crescimento e o desenvolvimento dos neonatos. Objetivo: Analisar as características clinicas e fonoaudiológicas de neonatos hospitalizados na unidade de tratamento intensivo (UTI) neonatal com suspeita de doença genética. Material e Método:Estudo transversal descritivo, conduzido em um hospital na região sul do Brasil com coleta de dados entre novembro de 2020 e setembro de 2021. Todos os neonatos que se encontravam internados na UTI, atendidos pelo Sistema Único de Saúde e que apresentavam suspeita de etiologias genéticas foram acompanhados pela equipe de Fonoaudiologia. Foram analisados todos os prontuários dos recém-nascidos com suspeita de alteração genética, extraindo-se os dados médicos e fonoaudiológicos. Resultados:A amostra foi constituída por 14 neonatos prematuros com média de idade gestacional de 36 semanas e 5 dias e uma média de tempo de nascimento, no momento da avaliação fonoaudiológica, de 14,6 dias de vida. No que se refere às comorbidades, 71,4% dos recém-nascidos apresentavam alguma malformação, sendo múltiplas na maior parte dos casos (64,29%). Todos os neonatos estavam fazendo uso de via enteral de alimentação durante a avaliação fonoaudiológica. Na avaliação de reflexos orais, observou-se que houve um predomínio de pacientes com reflexo de procura débil, sendo que a maior parte apresentava reflexo de sucção presente. Conclusões: Pode-se afirmar que, neste estudo, a amostra foi composta por pacientes principalmente prematuros que apresentavam malformações múltiplas e que todos faziam uso de via alternativa de alimentação sugerindo, assim, a necessidade de atendimento fonoaudiológico como parte da assistência multidisciplinar desses neonatos. (AU)


Introduction: Prematurity is a risk factor for the growth and development of neonates. Objective: To analyze clinical and speech therapy characteristics of neonates hospitalized in the neonatal intensive care unit with suspected genetic disease. Method: Descriptive cross-sectional study conducted in a hospital in southern Brazil with data collection between November 2020 and September 2021. All neonates who were hospitalized in the ICU attended by the public health system and who were suspected of having genetic etiologies were followed up by the Speech-Language Pathology team. All newborn`s medical records with suspected genetic alterations were analyzed and the medical and the speech-language pathology data were analyzed. Results: The sample consisted of 14 premature neonates with a mean gestational age of 36 weeks and 5 days and a mean time of birth, at the time of the speech-language pathology assessment, of 14.6 days of life. Regarding to comorbidities, 71.4% of newborns had some malformation, being multiple in most cases (64.29%). All neonates were using enteral feeding at the time of the speech-language evaluation. At the oral reflexes evaluation it was observed that there was a predominance of patients with a weak rooting reflex and most of them had a present sucking reflex. Conclusions: In this study the sample consisted of mainly premature patients who had multiple malformations and all of them used an alternative feeding route, thus suggesting the demand for speech therapy as part of the multidisciplinary care of these neonates. (AU)


Introducción: La prematuridad es un factor de riesgo para el crecimiento y desarrollo de los recién nacidos. Objetivo: Analizar las características clinicas y de terapia del habla de recién nacidos hospitalizados en la unidad de cuidados intensivos neonatales (UCI) con sospecha de enfermedad genética. Método: Estudio transversal descriptivo realizado en un hospital en la región del Sur de Brasil. Todos los recién nacidos que fueron hospitalizados en la UTI y que tenían sospecha de tener etiologías genéticas, fueron atendidos por el equipo de Patología del Habla y Lenguaje. Se analizaron todas las historias clínicas de los recién nacidos con sospecha de alteraciones genéticas, extrayéndose datos médicos y de patología del habla y del lenguaje. Resultados: La muestra estuvo constituida por 14 neonatos prematuros con una edad gestacional media de 36 semanas. En cuanto a las comorbilidades, el 71,4% de los recién nacidos presentó alguna malformación, siendo múltiples en la mayoría de los casos (64,29%). Con respecto a los datos de la evaluación de la patología del habla y el lenguaje, todos los recién nacidos estaban usando alimentación enteral. En la evaluación de los reflejos orales, se observó que hubo un predominio de pacientes con reflejo de búsqueda débil, y la mayoría de ellos tenían presente el reflejo de succión. Conclusiones: Se puede decir que en este estudio la muestra estuvo compuesta principalmente por pacientes prematuros, que presentaban plurimalformaciones y que todos utilizaban una vía alternativa de alimentación, sugiriendo así, la necesidad de la fonoaudiología como parte del cuidado multidisciplinario de estos neonatos. (AU)


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant, Premature , Intensive Care Units, Neonatal , Genetic Diseases, Inborn , Sucking Behavior , Abnormalities, Multiple , Cross-Sectional Studies , Enteral Nutrition , Speech, Language and Hearing Sciences , Electronic Health Records
11.
Cambios rev. méd ; 22(1): 862, 30 Junio 2023. ilus, tabs
Article in Spanish | LILACS | ID: biblio-1451458

ABSTRACT

de la deglución, los cuales representan todas las alteraciones del proceso fisiológico encargado de llevar el alimento desde la boca al esófago y después al estómago, salvaguardando siempre la protección de las vías respiratorias. OBJETIVO. Definir el manejo óptimo, de la disfagia en pacientes con antecedente de infección severa por COVID-19. METODOLOGÍA. Se realizó una revisión de la literatura científica en las bases de datos PubMed y Elsevier que relacionan el manejo de la disfagia y pacientes con antecedente de infección severa por SARS-CoV-2. Se obtuvo un universo de 134 artículos que cumplieron los criterios de búsqueda. Se seleccionaron 24 documentos, para ser considerados en este estudio. RESULTADOS. La incidencia de disfagia posterior a infección severa por SARS-CoV-2 fue del 23,14%, siendo la disfagia leve la más frecuente 48,0%. Los tratamientos clínicos más empleados en el manejo de la disfagia fueron rehabilitación oral y cambio de textura en la dieta en el 77,23% de los casos, mientras que el único tratamiento quirúrgico empleado fue la traqueotomía 37,31%. Un 12,68% de pacientes recuperó su función deglutoria sin un tratamiento específico. La eficacia de los tratamientos clínicos y quirúrgicos en los pacientes sobrevivientes de la infección severa por SARS-CoV-2 fue del 80,68%, con una media en el tiempo de resolución de 58 días. CONCLUSIÓN. La anamnesis es clave para el diagnóstico de disfagia post COVID-19. El tratamiento puede variar, desde un manejo conservador como cambios en la textura de la dieta hasta tratamientos más invasivos como traqueotomía para mejorar la función deglutoria.


INTRODUCTION. The difficulty to swallow or dysphagia is included within the problems of swallowing, which represent all the alterations of the physiological process in charge of carrying the food from the mouth to the esophagus, and then to the stomach, always taking into account the protection of the airways. OBJECTIVE. To define the optimal management, both clinical and surgical, for the adequate treatment of dysphagia produced as a consequence of severe SARS-CoV-2 infection. METHODOLOGY. A review of the scientific literature was carried out using both PubMed and Elsevier databases, which relate the management of dysphagia and patients with a history of severe SARS-CoV-2 infection. RESULTS. The incidence of dysphagia following severe SARS-CoV-2 infection was of 23,14%, with mild dysphagia being the most frequent 48,00%. The most frequently used clinical treatments for dysphagia management were oral rehabilitation and change in dietary texture in 77,23% of cases, while tracheotomy was the only surgical treatment used 37,31%. A total of 12,68% of patients recovered their swallowing function without specific treatment. The efficacy of clinical and surgical treatments in survivors of severe SARS-CoV-2 infection was 80,68%, with a mean resolution time of 58 days. CONCLUSION. An adequate medical history is key to the diagnosis of post-COVID-19 dysphagia. Treatment can range from conservative management such as changes in diet texture to more invasive treatments such as tracheotomy to improve swallowing function.


Subject(s)
Rehabilitation , Respiration, Artificial , Tracheotomy , Deglutition Disorders/therapy , Deglutition/physiology , COVID-19 , Otolaryngology , Rehabilitation of Speech and Language Disorders , Respiratory Tract Diseases , Speech , Tertiary Healthcare , Pulmonary Medicine , Deglutition Disorders , Respiratory Mechanics , Enteral Nutrition , Aerophagy , Dysgeusia , Ecuador , Exercise Therapy , Pathologists , Gastroenterology , Anosmia , Glossopharyngeal Nerve , Intensive Care Units , Intubation, Intratracheal
12.
Rev. chil. cardiol ; 42(1): 14-22, abr. 2023. tab
Article in Spanish | LILACS | ID: biblio-1441372

ABSTRACT

Antecedentes: Los dispositivos de asistencia ventricular (VAD, sigla en inglés) se utilizan cada vez más para el manejo de la insuficiencia cardíaca descompensada en unidades de cuidados intensivos. El manejo nutricional es fundamental para la evolución clínica de estos pacientes. Objetivos: El objetivo fue evaluar en cuánto tiempo se puede alcanzar las necesidades nutricionales, utilizando distintas modalidades de apoyo nutricional, en pacientes que requirieron asistencia con VAD por insuficiencia cardíaca aguda en una clínica privada del país. Métodos: En una clínica privada se efectuó un estudio observacional retrospectivo analizando los datos clínicos relacionados al aporte nutricional de 12 pacientes que requirieron asistencia con VAD. Las vías de aporte nutricional evaluadas fueron la nutrición enteral (NE) y/o nutrición parenteral (NP). Se midió el tiempo de implementación del apoyo nutricional y su efecto se estimó por una valoración nutricional subjetiva y por la medición de indicadores de laboratorio. Además, se vigilaron las complicaciones asociadas al aporte nutricional. Resultados: El estudio incluyó a 12 pacientes. Los objetivos nutricionales se alcanzaron por completo en el 91% de los pacientes (n=11) en 3,7 ± 1 días después de iniciado el apoyo nutricional. En ese momento, 5 pacientes recibían NE exclusiva, 4 pacientes NP complementaria a la NE, 1 paciente NE complementaria a la alimentación oral y 1 paciente con vía oral. Al momento de alcanzar los requerimientos nutricionales ningún paciente tenía NP exclusiva. Conclusión: Concluimos que el apoyo nutricional precoz es factible y seguro en pacientes con VAD. Alcanzar los objetivos nutricionales es posible sin efectos adversos graves. Se necesitan estudios futuros para determinar el beneficio a largo plazo del apoyo nutricional agresivo para pacientes en estado crítico que requieren apoyo hemodinámico.


Background: Ventricular assist devices (VAD) are being used more frequently in patients with severe heart failure. Nutritional support is a critical factor for the outcome in these patients. Aim: to evaluate the time required and mode of nutritional support in patients with severe cardiac dysfunction being treated with VAD. Methods: 12 patients with VAD being treated in an intensive care unit were evaluated to determine the time and mode of support required to achieve adequate nutrition. Enteral and / or parenteral modes of nutritional support were used. The outcomes were evaluated by subjective appreciation, weight measurement and serum levels of albumin, pre-albumin and vitamin D. Results: Adequate nutritional support was achieved in 91% of patients a mean of 3 days after beginning of treatment (SD 1 day). At that time 5 patients were receiving only enteral nutrition, 4 patients enteral and parenteral nutrition, 1 patient enteral nutrition in addition to oral nutrition and 1 patients was receiving only oral nutrition. No patient was receiving only parenteral nutrition. Conclusion: early nutritional support is posible and safe in patients with an VAD. Further studies are needed to evaluate long term benefits of this strategy of nutritional support.


Subject(s)
Humans , Extracorporeal Membrane Oxygenation/methods , Nutrition Assessment , Heart-Assist Devices , Parenteral Nutrition/methods , Retrospective Studies , Enteral Nutrition/methods , Nutritional Support/adverse effects , Heart Failure/complications
13.
Enferm. foco (Brasília) ; 14: 1-7, mar. 20, 2023. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1428655

ABSTRACT

Objetivo: O registro dos dados referentes a Terapia Nutricional Enteral (TNE) é importante para assegurar o procedimento e comunicação sistemática da assistência. Com o estudo, objetivou-se analisar os registros de enfermagem referentes à inserção de cateteres nasogástricos (CNG) e nasoenterais (CNE) considerando o sub-registro e não conformidades encontradas em prontuários e durante observação dos pacientes. Métodos: estudo observacional, transversal com abordagem quantitativa, mediante a aplicação de instrumento para coleta de dados de pacientes internados em um Hospital Universitário no Pará entre agosto de 2019 a julho de 2020. Resultados: Foram identificadas 191 inserções de cateteres por enfermeiros, sendo 43 (22,52%) reinserções sub-registradas e 148 (77,48%) apresentaram não conformidades. Discussão: O sub-registro e as não conformidades interferem na qualidade da assistência de enfermagem, fragilizam as ações de segurança do paciente, além de apresentarem repercussões legais. Conclusão: Os dados apresentados neste artigo foram primordiais para a detecção de lacunas na assistência de enfermagem. (AU)


Objective: The recording of data referring to Enteral Nutrition Therapy (ENT) is important to ensure the procedure and systematic communication of care. The objective was to analyze the nursing records regarding the insertion of nasogastric (CNG) and nasoenteral (CNE) catheters, considering the under-recording and non-conformities found in medical records and during patient observation. Methods: observational, cross-sectional study with a quantitative approach, through the application of an instrument to collect data from patients admitted to a University Hospital in Pará between August 2019 and July 2020. Results: 191 insertions of catheters by nurses were identified, of which 43 (22.52%) underreported reinsertion and 148 (77.48%) presented non-conformities. Discussion: Under-registration and non-compliance interfere with the quality of nursing care, weaken patient safety actions, in addition to having legal repercussions. Conclusion: The data presented in this article were essential for the detection of gaps in nursing care. (AU)


Objetivo: El registro de los datos referentes a la Terapia de Nutrición Enteral (ENT) es importante para garantizar el procedimiento y la comunicación sistemática de los cuidados. El objetivo fue analizar los registros de enfermería con respecto a la inserción de catéteres nasogástricos (GNC) y nasoenterales (CNE), considerando el subregistro y las no conformidades encontradas en los registros médicos y durante la observación de los pacientes. Métodos: estudio observacional, transversal con abordaje cuantitativo, mediante la aplicación de un instrumento para recolectar datos de pacientes internados en un Hospital Universitario de Pará entre agosto de 2019 y julio de 2020. Resultados: fueron identificadas 191 inserciones de catéteres por enfermeros, de de los cuales 43 (22,52%) subreportaron reinserción y 148 (77,48%) presentaron no conformidades. Discusión: El subregistro y el incumplimiento interfieren en la calidad de la atención de enfermería, debilitan las acciones de seguridad del paciente, además de tener repercusiones legales. Conclusión: Los datos presentados en este artículo fueron esenciales para la detección de lagunas en el cuidado de enfermería. (AU)


Subject(s)
Nursing Records , Underregistration , Enteral Nutrition , Continuity of Patient Care
14.
Chinese Critical Care Medicine ; (12): 968-974, 2023.
Article in Chinese | WPRIM | ID: wpr-1010893

ABSTRACT

OBJECTIVE@#To systematically review safety and tolerance of enteral nutrition (EN) in a prone position, as well as the risks of increased gastric residual volume (GRV), vomiting, aspiration, and ventilator-associated pneumonia, and determine the ways to improve EN tolerance in patients with acute respiratory distress syndrome (ARDS).@*METHODS@#Databases including PubMed, Embase and Wanfang Medical data of the English and Chinese literatures were retrieved up from January 1979 to January 2022 to collet the randomized controlled trial (RCT), non-RCT, and observational studies, concerning safety and tolerance of EN in a prone position with ARDS. All trials must have a minimum of two patient groups, one of which must be prone to ARDS and receive EN. Data searching extracting and quality evaluation were assessed by two reviewers independently. RevMan 5.4 software was used for analysis.@*RESULTS@#A total of 9 studies were included, including 2 RCTs, 2 non-RCTs, 4 prospective observational studies, and 1 retrospective observational study. The starting and increasing rate of EN were typically well tolerated in the prone position compared to the supine position in patients with ARDS, there was no significant increase in GRV (mL: 95 vs. 110), and the incidence of vomiting was not noticeably higher (0%-35% vs. 33%-57%). The incidence of ventilator-associated pneumonia with EN was not significantly higher in the prone position than in the supine position in patients with ARDS (6%-35% vs. 15%-24%). Aspiration occurred at a similar rate in patients in the nasogastric tube and post-pyloric feeding groups with EN in patients with ARDS in the prone position (22% vs. 20%). EN tolerability with nasogastric and nasojejunal tubes was similar in prone positions, with no significant difference in EN intolerance incidences (15% vs. 22%). Head elevation (30 degree angle-45 degree angle) improved EN tolerance in the prone position in patients with ARDS, thereby increasing the early EN dose [odds ratio (OR) = 0.48, 95% confidence interval (95%CI) was 0.22-1.08, P = 0.08]. Additionally, prophylactic application of gastrointestinal motility drugs, such as erythromycin, at the start of EN in a prone position significantly improved patients' EN tolerance (OR = 1.14, 95%CI was 0.63-2.05, P = 0.67).@*CONCLUSIONS@#The use of gastric tube for EN in prone position and similar feeding speed to the supine position in patients with ARDS is safe and well tolerated. The initiation and dosing of EN should not be delayed in the prone position. EN tolerance may be increased by elevating the head of the bed during enteral feeding in a prone position, and gastrointestinal motility medications should be promptly administered with EN initiation in patients with ARDS.


Subject(s)
Humans , Pneumonia, Ventilator-Associated/etiology , Enteral Nutrition , Prone Position , Respiration, Artificial/adverse effects , Respiratory Distress Syndrome, Newborn/etiology , Randomized Controlled Trials as Topic , Observational Studies as Topic
15.
Chinese Journal of Traumatology ; (6): 236-243, 2023.
Article in English | WPRIM | ID: wpr-981921

ABSTRACT

Blunt bowel injury (BBI) is relatively rare but life-threatening when delayed in surgical repair or anastomosis. Providing enteral nutrition (EN) in BBI patients with open abdomen after damage control surgery is challenging, especially for those with discontinuity of the bowel. Here, we report a 47-year-old male driver who was involved in a motor vehicle collision and developed ascites on post-trauma day 3. Emergency exploratory laparotomy at a local hospital revealed a complete rupture of the jejunum and then primary anastomosis was performed. Postoperatively, the patient was transferred to our trauma center for septic shock and hyperbilirubinemia. Following salvage resuscitation, damage control laparotomy with open abdomen was performed for abdominal sepsis, and a temporary double enterostomy (TDE) was created where the anastomosis was ruptured. Given the TDE and high risk of malnutrition, multiple portions EN were performed, including a proximal portion EN support through a nasogastric tube and a distal portion EN via a jejunal feeding tube. Besides, chyme delivered from the proximal portion of TDE was injected into the distal portion of TDE via a jejunal feeding tube. Hyperbilirubinemia was alleviated with the increase in chyme reinfusion. After 6 months of home EN and chyme reinfusion, the patient finally underwent TDE reversal and abdominal wall reconstruction and was discharged with a regular diet. For BBI patients with postoperative hyperbilirubinemia who underwent open abdomen, the combination of multiple portions EN and chyme reinfusion may be a feasible and safe option.


Subject(s)
Male , Humans , Middle Aged , Enteral Nutrition , Intestines/surgery , Intestinal Diseases , Abdomen/surgery , Anastomosis, Surgical , Abdominal Injuries/surgery
16.
Chinese Journal of Contemporary Pediatrics ; (12): 1270-1275, 2023.
Article in Chinese | WPRIM | ID: wpr-1009880

ABSTRACT

OBJECTIVES@#To summarize the clinical characteristics and nutrition therapy for children with lysinuric protein intolerance (LPI).@*METHODS@#The clinical manifestations, laboratory test results and enteral nutrition treatment in a girl with LPI diagnosed in Xiangya Hospital, Central South University were retrospective analyzed. Additionally, the data of the children with LPI reported in China and overseas were reviewed.@*RESULTS@#A case of 4-year-old girl was presented, who exhibited significant gastrointestinal symptoms, such as chronic abdominal distension, prolonged diarrhea, recurrent pneumonia, and limited growth. She had a poor response to anti-infection treatment. After receiving enteral nutrition therapy, she did not experience any gastrointestinal discomfort, and there were improvements in the levels of hemoglobin, albumin, and blood ammonia. Unfortunately, due to serious illness, she declined further treatment and later passed away. A total of 92 cases of pediatric patients with LPI have been reported to date, including one case reported in this study. Most children with LPI experienced disease onset after weaning or introduction of complementary foods, presenting with severe digestive system symptoms, malnutrition, and growth retardation. It is noteworthy that only 50% (46/92) of these cases received nutritional therapy, which effectively improved their nutritional status. Among the 92 children, 8 (9%) died, and long-term follow-up data were lacking in other reports.@*CONCLUSIONS@#LPI often involves the digestive system and may result in growth restriction with a poor prognosis. Nutritional therapy plays a crucial role in the comprehensive treatment of LPI.


Subject(s)
Child, Preschool , Female , Humans , Amino Acid Metabolism, Inborn Errors/therapy , Enteral Nutrition/methods , Malnutrition , Retrospective Studies
17.
Chinese Critical Care Medicine ; (12): 435-437, 2023.
Article in Chinese | WPRIM | ID: wpr-982608

ABSTRACT

Difficulty in swallowing is a common symptom in stroke patients, and nasogastric tubes are routinely used to solve the nutritional support problem of these patients. The existing nasogastric tube have the disadvantages of causing aspiration pneumonia and patient discomfort. The traditional transoral gastric tube has no one-way valve switch and gastric content storage device, and cannot be fixed in the stomach, resulting in reflux of gastric contents, inability to fully understand the digestion and absorption of gastric contents, and accidental dislocation of the gastric tube, affecting further feeding and gastric content detection. For these reasons, the medical staff of the department of gastroenterology and colorectal surgery of Jilin University China-Japan Union Hospital designed a new transoral gastric tube that can extract and store gastric contents, and was granted a national utility model patent of China (ZL 2020 2 1704393.1). The device consists of collection, cannula and fixation modules. The collection module includes three parts. Gastric contents storage capsule, which can clearly visualize the gastric contents; three-way switch, which can be controlled by rotating the pathway, makes the pathway exist in different states, which is convenient for medical personnel to extract gastric juice, as well as perform intermittent oral tube feeding on the patient or close the pipeline, and reduce contamination and prolong the service life of the gastric tube; one-way valve, which can effectively avoid the contents of the reflux back into the stomach. The tube insertion module includes three parts. A graduated tube, which can enable the medical staff to effectively identify the insertion depth; a solid guide head, which makes the insertion of the tube through the mouth more smoothly; the gourd-shaped passageway, which effectively avoids the blockage of the tube. The fixation module is a water-filled balloon, which is properly filled with water and air. After the pipe is inserted through the mouth, it can be injected with water and gas properly to avoid accidental withdrawal of the gastric tube. Intermittent oroesophageal tube feeding of patients with dysphagia after stroke through a transoral gastric tube that can extract and store gastric contents can not only accelerate the recovery process of patients and shorten the hospitalization time, but also transoral enteral nutrition can effectively promote the recovery of patients' systemic systems, which has certain clinical use value.


Subject(s)
Humans , Enteral Nutrition , Aircraft , Cannula , China , Drug Contamination
18.
Chinese Critical Care Medicine ; (12): 409-414, 2023.
Article in Chinese | WPRIM | ID: wpr-982603

ABSTRACT

OBJECTIVE@#To investigate whether dynamic monitoring of citrulline (Cit) has guiding value for early enteral nutrition (EN) in patients with severe gastrointestinal injury.@*METHODS@#A observational study was conducted. A total of 76 patients with severe gastrointestinal injury admitted to different intensive care units of Suzhou Hospital Affiliated to Nanjing Medical University from February 2021 to June 2022 were enrolled. Early EN was performed in 24-48 hours after admission as recommended by the guidelines. Those who did not terminate EN after 7 days were enrolled in the early EN success group, and those who terminated EN within 7 days due to persistent feeding intolerance or deterioration of general condition were enrolled in the early EN failure group. There was no intervention during the treatment. Serum Cit levels were measured by mass spectrometry at admission, before EN starting and EN 24 hours, respectively, and the changes in Cit within EN 24 hours (ΔCit) were calculated (ΔCit = EN 24-hour Cit-Cit before EN starting). Receiver operator characteristic curve (ROC curve) was plotted to investigate the predictive value of ΔCit for early EN failure, and the optimal predictive value was calculated. Multivariate unconditional Logistic regression was used to analyze the independent risk factors for early EN failure and death at 28 days.@*RESULTS@#Seventy-six patients were enrolled in the final analysis, of which 40 succeeded in early EN and 36 failed. There were significant differences in age, main diagnosis, acute physiology and chronic health evaluation II (APACHE II) score at admission, blood lactic acid (Lac) before EN initiation and ΔCit between the two groups. Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 0.929, 95% confidence interval (95%CI) was 0.874-0.988, P = 0.018], ΔCit (OR = 2.026, 95%CI was 1.322-3.114, P = 0.001) and increased feeding rate within 48 hours (OR = 13.719, 95%CI was 1.795-104.851, P = 0.012) were independent risk factors for early EN failure in patients with severe gastrointestinal injury. ROC curve analysis showed that ΔCit had a good predictive value for early EN failure in patients with severe gastrointestinal injury [area under the ROC curve (AUC) = 0.787, 95%CI was 0.686-0.887, P < 0.001], and the optimal predictive value of ΔCit was 0.74 μmol/L (sensitivity was 65.0%, specificity was 75.0%). Combined with the optimal predictive value of ΔCit, "overfeeding" was defined as ΔCit < 0.74 μmol/L and increased feeding within 48 hours. Multivariate Logistic regression analysis showed that age (OR = 0.825, 95%CI was 0.732-0.930, P = 0.002), APACHE II score (OR = 0.696, 95%CI was 0.518-0.936, P = 0.017) and early EN failure (OR = 181.803, 95%CI was 3.916-8 439.606, P = 0.008) were independent risk factors for 28-day death in patients with severe gastrointestinal injury. The new variable "overfeeding" was also associated with an increased risk of death at 28 days (OR = 27.816, 95%CI was 1.023-755.996, P = 0.048).@*CONCLUSIONS@#Dynamic monitoring of Cit has guiding value for early EN in patients with severe gastrointestinal injury.


Subject(s)
Humans , Infant, Newborn , Enteral Nutrition , Citrulline , APACHE , Abdominal Injuries , Cognition , Thoracic Injuries
19.
Chinese Journal of Gastrointestinal Surgery ; (12): 401-409, 2023.
Article in Chinese | WPRIM | ID: wpr-982182

ABSTRACT

Small bowel obstruction is a common surgical acute abdomen, with high rates of missed diagnosis, misdiagnosis, mortality and disability. The majority of patients with small bowel obstruction can be relieved by early non-operative treatment and intestinal obstruction catheter. However, there are still many controversies about the window of observation, the time of emergency operation and the method of operation. In recent years, the basic and clinical research on small bowel obstruction has made further progress, but there is no authoritative reference in clinical practice, and there is no relevant consensus and guidelines to standardize the diagnosis and treatment of small bowel obstruction in China. Accordingly, on the initiative of the Chinese Society for Parenteral and Enteral Nutrition and Enhanced Recovery after Surgery Branch of China International Health Care Promotion Exchange Association. The experts in this field of our country constitute the editorial committee, and refer to the main results of the current domestic and foreign research. According to the GRADE system of evidence quality assessment and recommendation intensity grading, the Chinese expert consensus on the diagnosis and treatment of small bowel obstruction was formulated for the study and reference of related specialties. It is expected to improve the overall level of diagnosis and treatment of small bowel obstruction in our country.


Subject(s)
Humans , Consensus , Enteral Nutrition , Intestinal Obstruction/surgery , Parenteral Nutrition , China
20.
Ribeirão Preto; s.n; 2023. 100 p. ilus.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-1554758

ABSTRACT

Objetivo: descrever a etapa de criação do protótipo de um aplicativo móvel, baseado em evidências, com informações sobre os cuidados de enfermagem para utilização de sonda enteral em pacientes cirúrgicos oncológicos. Método: estudo metodológico com uso do design instrucional fixo, que percorreu as fases de análise, desenho e desenvolvimento. Foram realizados storyboards com base nas evidências dos principais conteúdos sobre a administração de dietas e de medicamentos via sondas enterais nos seguintes guidelines: Diretrizes Brasileiras de Práticas de Enfermagem e Diretriz Americana de Práticas Seguras para Terapia de Nutrição Enteral. Resultados: na etapa de desenho, foram mapeados os conteúdos que entrariam no aplicativo e elaborados dois roteiros, denominados storyboards, sendo um para o cuidado durante a Administração de Dietas e outro para o cuidado na etapa de Administração de Medicamentos. Nos storyboards, foram descritas as sequências das telas, o conteúdo que seria apresentado em cada uma delas sob forma de texto e de imagem e como esse conteúdo deveria ser organizado no layout da tela. Os storyboards foram submetidos à validação de conteúdo por seis enfermeiros especialistas da área. Em seguida, foram realizados ajustes nos conteúdos e forma de apresentação descritos nos storyboards. Conclusão: o protótipo de aplicativo baseado em evidências científicas atuais é uma ferramenta tecnológica que poderá ser consultada pela equipe de enfermagem durante o cuidado à beira do leito, aumentando a segurança do paciente. O embasamento científico e metodológico para o desenvolvimento do storyboard viabiliza a confiabilidade do produto educativo. Ademais, a validação de conteúdo e aparência por especialistas na área torna tal dispositivo seguro para o público-alvo e uma importante ferramenta profissional, passível de ser utilizada como atividade de educação em saúde


Objective: describe the step of creating the prototype of a mobile application, based on evidence, with information about nursing care for the use of enteral tubes in surgical oncology patients. Method: methodological study using fixed instructional design, which went through the phases of analysis, design, and development. Storyboards were made based on the evidence of the main contents about the administration of diets and medications via enteral tubes in the following guidelines: Brazilian Guidelines for Nursing Practice and American Guideline for Safe Practices for Enteral Nutrition Therapy. Results: in the design stage, the contents that would enter the application were mapped and two scripts were developed, called storyboards, one for the care during Diet Administration and the other for the care in the Medication Administration stage. The storyboards described the screen sequences, the content that would be presented on each screen in text and image form, and how this content should be organized in the screen layout. The storyboards were submitted for content validation by five specialist nurses. Then, adjustments were made to the content and presentation form described in the storyboards. Conclusion: the prototype application based on current scientific evidence is a technological tool that can be consulted by the nursing team during bedside care, increasing patient safety. The scientific and methodological basis for the storyboard development enables the reliability of the educational product. Moreover, the validation of content and appearance by experts in the field makes this device safe for the target audience and an important professional tool, which can be used as a health education activity


Subject(s)
Humans , Enteral Nutrition/nursing , Educational Technology , Mobile Applications/standards , Intubation, Gastrointestinal/nursing
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