Cartolano Flávia De Conti, Caruso Lúcia, Soriano Francisco Garcia
Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil.
Unidade da Terapia Intensiva Adulto, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil.
Rev Bras Ter Intensiva. 2009 Dec;21(4):376-83.
Monitor the adequacy of enteral nutritional therapy at the intensive care unit aiming to improve the quality of nutritional assistance.
Prospective and observational study developed at the adult intensive care unit from 2005 to 2008. Patients over 18 years of age with exclusive enteral nutritional therapy for over 72h participated in the sample. The average values and the percentile adequacy of energy and proteins calculated, prescribed and administered in each year were analyzed. The factors responsible for the non-conformity of the administration planned were classified into intensive care unit extrinsic or intrinsic causes. The quality indicators proposed by the ILSI Brazil were applied, and expressed into percentile goals. In the statistic analyses, confidence interval and the t Student e Mann-Whitney (p<0.05) tests were used, according to the Epi Info program.
One hundred and sixteen patients were followed up. There were statically difference in values of energy and protein administered in 2005 and in 2006, when compared to those in 2008. The adequacy calculated/prescribed remained close to 100% in all the surveys and the adequacy administered/prescribed increased from 74% in 2005, to 89% in 2008. An increase in interruptions of enteral nutritional therapy for external factors and the decrease in interruptions for intensive care unit internal factors were verified. The quality indicators equally reflect the evolution of the patient care.
In the four yearly surveys, a progressive enhancement of nutritional support was verified. Quality indicators allow nutritional care evolution monitoring, the comparison to other services data, and are a new perspective for enteral nutritional therapy assessment.
监测重症监护病房肠内营养治疗的充分性，旨在提高营养支持质量。
2005年至2008年在成人重症监护病房开展的前瞻性观察研究。18岁以上接受肠内营养治疗超过72小时的患者纳入样本。分析每年计算、规定和给予的能量及蛋白质的平均值和百分位数充足率。将导致计划给药不符合的因素分为重症监护病房外部或内部原因。应用巴西国际生命科学研究所提出的质量指标，并将其表示为百分位数目标。在统计分析中，根据Epi Info程序使用置信区间以及t检验和曼-惠特尼检验（p<0.05）。
对116例患者进行了随访。与2008年相比，2005年和2006年给予的能量和蛋白质值存在统计学差异。在所有调查中，计算/规定的充足率均接近100%，给予/规定的充足率从2005年的74%提高到2008年的89%。已证实因外部因素导致的肠内营养治疗中断增加，而因重症监护病房内部因素导致的中断减少。质量指标同样反映了患者护理的进展。
在四年的调查中，证实了营养支持的逐步改善。质量指标可用于监测营养护理的进展、与其他服务数据进行比较，并且是评估肠内营养治疗的新视角。
