OPINIÕES DOS PROFISSIONAIS DE TERAPIA INTENSIVA SOBRE OS PROCEDIMENTOS DE REALIMENTAÇÃO ORAL EM PACIENTES NEUROCRÍTICOS
Resumo
Procurou-se verificar o procedimento que profissionais e estudantes que atuam em unidade de terapia intensiva (UTI) adotam para realimentação oral em pacientes neurológicos agudos após saída da ventilação mecânica, através de um questionário aplicado a profissionais de saúde (médicos intensivistas, neurologistas e enfermagem da UTI), residentes médicos e estudantes de medicina em um hospital público de ensino. O questionário continha questões sobre critérios de consistência de alimentos e questões para escolher a melhor dieta oral para pacientes com doenças neurológicas agudas. A pesquisa foi respondida por 14 médicos, 9 residentes, 13 estudantes de medicina e 21 profissionais de enfermagem. Foi feita estatística descritiva e comparação entre as médias, com análise univariada. Os parâmetros mais citados para indicar realimentação oral foram: adequado nível de consciência, eficiência da deglutição, e estabilidade gastrointestinal. As consistências de alimentos mais frequentemente citadas para realimentação oral foram pastosos e semipastosos. Contudo, houve várias respostas contraditórias sobre consistência de alimentos, particularmente sobre líquidos. Vários profissionais e estudantes demonstraram pouca preocupação sobre aspectos de disfagia nestes pacientes. Não há concordância sobre procedimentos de realimentação oral no paciente neurocrítico agudo entre profissionais atuantes em terapia intensiva, principalmente sobre selecionar a consistência de alimento a ser testada e no reconhecimento da importância da disfagia neste grupo.
Palavras-chave
Texto completo:
PDFReferências
Artinian, V; Krayem, H; Digiovine, B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated patients. Chest 2006; 129: 960-7.
Marik P; Zaloga G. Early enteral nutrition in the acutelly ill patients: A systematic review. Crit Care Med 2001; 29: 2264-70.
Fulbrook, P; Bongers, A; Albarran, JW. A european survey of enteral nutrition practices and procedures in adult intensive care units. J Clin Nurs 2007; 16: 2132-41.
Nematy, M; O´Flynn, Je; Wandrag, L; Brynes, AE; Brett, SJ; Patterson, M; et al. Changes in appetite-related gut hormones in intensive care unit patients: a pilot cohort study. Crit Care 2006; 10: R10-18.
Sonies, BC. Oropharyngeal dysphagia in the elderly. Clin Geriatr Med 1992; 8: 569-77.
Brown, CV; Hejl, K; Mandaville, AD; Chaney, PE; Stevenson, G; Smith, C. Swallowing dysfunction after mechanical ventilation in trauma patients. J Crit Care 2011; 26 (1):108-13.
De Vita, M; Spierer-Rundback, L. Swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes. Crit Care Med 1990; 18 (12): 1328-1330.
Romero, CM; Marambio, A; Larrondo, J; Walker, K; Lira, MT; Tobar, E; Cornejo, R; Ruiz, M. Swallowing dysfunction in nonneurologic critically ill patients who require percutaneous dilatational tracheostomy. Chest 2010; 137 (6): 1278-82.
Warnecke, T; Suntrup, S; Teismann, IK; Hamacher, C; Oelenberg, S; Dziewas, R. Standardized endoscopic swallowing evaluation for tracheostomy decannulation in critically ill neurologic patients. Crit Care Med 2013; 41 (7): 1728-32.
Terré, R; Mearin, F. Prospective evaluation of oro-pharyngeal dysphagia after severe traumatic brain injury. Brain Inj 2007; 21 (13-14): 1411-1417.
Goldsmith, T. Evaluation and treatment of swallowing disorders following endotracheal intubation and tracheostomy. Int Anesthesiol Clin 2000; 38 (3): 219-42.
Mackay, LE; Morgan, AS; Bernstein, BA. Swallowing disorders in severe brain injury: risk factors affecting return to oral intake. Arch Phys Med Rehabil 1999; 80 (4): 365-71.
Macht, M; Wimbish, T; Clark, BJ; Benson, AB; Burnham, EL; Williams, A; et al. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit Care 2011; 15 (5): R231.
Barquist, E; Brown, M; Cohn, S; Lundy, D; Jackowski, J. Postextubation fiberoptic endoscopic evaluation of swallowing after prolonged endotracheal intubation: a randomized, prospective trial. Crit Care Med 2001; 29 (9): 1710-1713.
Clavé, P; Arreola, V; Velasco, M, Quer, M; Castellví, JM; Almirall, J; et al. Diagnosis and treatment of functional oropharyngeal dysphagia. Features of interest to the digestive surgeon. Cir Esp 2007; 82 (2): 62-76.
Macht, M; Wimbish, T; Clark, BJ; Benson, AB; Burnham, EL; Williams, A; et al. Diagnosis and treatment of post-extubation dysphagia: results from a national survey. J Crit Care 2012; 27 (6): 578-86.
Splaingard, M; Hutchins, B; Sulton, L; Chaudhuri, G. Aspiration in rehabilitation patients: videofluoroscopic vs bedside clinical assesment. Arch Phys Med Rehabil 1988; 69 (8): 637-640.
McGowan, SL; Gleeson, M; Smith, M; Hirsch, N; Shuldham, CM. A pilot study of fibreoptic endoscopic evaluation of swallowing in patients with cuffed tracheostomies in neurological intensive care . Neurocrit Care 2007; 6 (2): 90-93.
Cameron, JL; Reynolds, J; Zuidem, GD. Aspiration in patients with tracheotomies. Surg Gynecol Obstet 1973; 136: 68-70.
Tolep, K; Getch, CL; Criner, G. Swallowing dysfunction in patients receiving prolonged mechanical ventilation. Chest 1996; 109 (1): 167-172.
Reissman, P; Teoh, TA; Cohen, SM, Weiss, EG; Nogueras, JJ; Wexner, SD . Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial. Ann Surg 1995; 222: 73-77.
Lassen, K; Revhaug, A. Early oral nutrition after major upper gastrointestinal surgery: why not? Curr Opin Clin Nutr Metab Care 2006; 9: 613-617.
Fukuzawa, J; Terashima, H. Early postoperative oral feeding accelerates upper gastrointestinal anastomotic healing in the rat model. World J Surg 2007; 31: 1234-1239.
Petrelli, NJ; Cheng, C; Driscoll, D; Rodriguez-Bigas, MA. Early postoperative oral feeding after colectomy: an analysis of factors that may predict failure. Ann Surg Oncol 2001; 8: 796-800.
Odderson, R; McKenna, S. A model for management of patients with stroke during the acute phase. Stroke 1993; 24 (12): 1823-1827.
American Dietetic Association. Manual of clinical dietetics. 6th ed. Chicago: American Dietetic Association, 2000.
Dietitians Association of Australia and The Speech Pathology Association of Australia. Texture-modified foods and thickened fluids as used for individuals with dysphagia: Australian standardised labels and definitions. Nutrition & Dietetics 2007; 64 (Suppl. 2): S53–S76.
Bisch, EM; Logemann, JA; Rademaker, AW; Kahrilas, PJ; Lazarus, CL. Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. J Speech Hear Res 1994; 37 (5): 1041-1059.
Pardoe, EM. Development of a multistage diet for dysphagia. J Am Diet Assoc 1993; 93 (5): 568-571.
Peterson, SJ; Tsai, AA; Scala, CM; Sowa, DC; Sheean, PM; Braunschweig, CL. Adequacy of oral intake in critically ill patients 1 week after extubation. J Am Diet Assoc 2010; 110 (3): 427-33.
DOI: http://dx.doi.org/10.5380/rmu.v1i3.40808
DOI (PDF): http://dx.doi.org/10.5380/rmu.v1i3.40808.g24948
Apontamentos
- Não há apontamentos.
