RESUMO
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Assuntos
Nutrição Enteral/métodos , Nutrição Enteral , Cuidados Críticos/organização & administração , Eritromicina/uso terapêutico , Fenômenos Fisiológicos da Nutrição , Alimentação de Emergência , Avaliação Nutricional , Socorro Alimentar , Planejamento Alimentar/normas , Planejamento Alimentar/organização & administração , Vigilância Alimentar e Nutricional/métodos , Alimentação de EmergênciaRESUMO
OBJECTIVE: To assess the frequency, complications, and value of prophylactic treatment of stress-induced gastroduodenal lesions. DESIGNS: Patients were prospectively randomized to treatment with total parenteral nutrition, either alone, with sucralfate, or with ranitidine. SETTING: A multidisciplinary ICU from a tertiary care referral center. PATIENTS: Ninety-seven patients submitted to prolonged mechanical ventilation, with normal hepatic and renal function, in metabolic stress, and receiving total parenteral nutrition. INTERVENTIONS: On admission, we determined the Acute Physiology and Chronic Health Evaluation II score and the catabolic index score. We also performed an endoscopic examination on day 3, every 7 days subsequently, and whenever needed. Thirty patients received total parenteral nutrition alone. Twenty-four patients received total parenteral nutrition and sucralfate (1 g by nasogastric tube every 4 hrs). Nineteen patients received total parenteral nutrition and ranitidine (50 mg iv every 6 hrs). MAIN RESULTS: The overall occurrence rate of gastroduodenal mucosal damage was 29.6%. The overall frequency rate for stress ulcerations was 15.6% and was 6.2% for stress hemorrhage. There were no deaths secondary to stress hemorrhage. The difference in the frequency of stress-induced mucosal lesions and stress hemorrhage between the studied groups was not statistically significant. CONCLUSIONS: Additional prophylaxis to total parenteral nutrition in the form of sucralfate and ranitidine to prevent acute upper gastrointestinal bleeding is not required in this group of ICU patients.
Assuntos
Hemorragia Gastrointestinal/terapia , Unidades de Terapia Intensiva , Nutrição Parenteral Total/normas , Úlcera Péptica/terapia , Ranitidina/uso terapêutico , Estresse Fisiológico/complicações , Sucralfato/uso terapêutico , Adolescente , Adulto , Idoso , Terapia Combinada , Endoscopia , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Úlcera Péptica/epidemiologia , Úlcera Péptica/etiologia , Estudos Prospectivos , Ranitidina/administração & dosagem , Respiração Artificial , Índice de Gravidade de Doença , Sucralfato/administração & dosagemRESUMO
Among the different etiologies of noncardiogenic acute pulmonary edema is found the administration or ingestion of various substances. We have studied two patients with ARDS secondary to the ingestion of toxic oil. Both patients presented similar roentgenographic findings characterized by interstitial and alveolar infiltration in "butterfly" distribution, pleural effusion, and a normal cardiac silhouette. The two cases also showed a pulmonary compliance either normal or slightly diminished. With the aid of artificial ventilation, they evolved favorably, gaseous exchange and chest x-ray films returning to normal 16 and 22 days after admission.