{"id":1855,"date":"2022-11-16T10:33:12","date_gmt":"2022-11-16T13:33:12","guid":{"rendered":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?p=1855"},"modified":"2022-11-16T10:35:01","modified_gmt":"2022-11-16T13:35:01","slug":"impacto-desnutricao-covid","status":"publish","type":"post","link":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/impacto-desnutricao-covid\/","title":{"rendered":"Como manejar o impacto da desnutri\u00e7\u00e3o em pacientes hospitalizados com covid-19?"},"content":{"rendered":"

Em pacientes com covid-19 que desenvolvem sua forma mais grave e que s\u00e3o admitidos em ambiente hospitalar ou mesmo unidades de terapia intensiva, a terapia nutricional \u00e9 parte essencial do cuidado e do suporte oferecido na aten\u00e7\u00e3o aos pacientes em quadros cr\u00edticos3<\/a>.<\/p>\n

 <\/p>\n

Ou seja, a nutri\u00e7\u00e3o cl\u00ednica adequada est\u00e1 entre uma das medidas de suporte essenciais. Ainda assim, o manejo desse tipo de paciente se mostra um desafio<\/strong>, seja pela sobrecarga a qual muitas unidades hospitalares enfrentaram durante a pandemia, seja pela falta de evid\u00eancias diante de uma doen\u00e7a que ainda \u00e9 nova, embora muito j\u00e1 tenha sido descoberto.<\/p>\n

 <\/p>\n

O diagn\u00f3stico da desnutri\u00e7\u00e3o<\/strong><\/h2>\n

\u00c9 comum que pacientes com quadros graves de covid-19 passem longos per\u00edodos hospitalizados, inclusive em unidades de terapia intensiva (UTI). \u00a0Nesse contexto, a nutri\u00e7\u00e3o apropriada est\u00e1 associada \u00e0 efetiva redu\u00e7\u00e3o de complica\u00e7\u00f5es e na melhoria dos desfechos, inclusive para pacientes em longos per\u00edodos de hospitaliza\u00e7\u00e3o. Logo, tomar os cuidados necess\u00e1rios para evitar e tratar desnutri\u00e7\u00e3o entre pacientes com covid-19 deve ser considerada como parte do manejo adequado para promover melhores progn\u00f3sticos1<\/a>.<\/strong><\/p>\n

 <\/p>\n

Assim, a identifica\u00e7\u00e3o do risco ou da presen\u00e7a de quadros de desnutri\u00e7\u00e3o deve ser um cuidado tomado desde os primeiros momentos da admiss\u00e3o dos pacientes com covid-19.<\/p>\n

 <\/p>\n

V\u00e1rios crit\u00e9rios podem ser empregados para o diagn\u00f3stico de desnutri\u00e7\u00e3o. Todavia, em\u00a0 editorial na<\/strong> Clinical Nutrition<\/strong><\/a>, os especialistas da European Society for Clinical Nutrition and Metabolism<\/em> (ESPEN) sugerem que sejam seguidos os crit\u00e9rio do <\/strong>GLIM<\/strong><\/a>2<\/a>\u00a0(Global Leadership Initiative on Malnutrition<\/em>).<\/strong><\/p>\n

 <\/p>\n

Tais par\u00e2metros refor\u00e7am que os diagn\u00f3sticos de desnutri\u00e7\u00e3o devem ser feitos em duas etapas<\/strong>: a primeira utilizando ferramentas j\u00e1 validadas e a segunda avaliando crit\u00e9rios diagn\u00f3sticos.\u00a0 Assim, a avalia\u00e7\u00e3o deve considerar a presen\u00e7a de ao menos um crit\u00e9rio fenot\u00edpico (perda de peso, baixo IMC ou redu\u00e7\u00e3o da massa muscular) e um crit\u00e9rio etiol\u00f3gico (inflama\u00e7\u00e3o ou redu\u00e7\u00e3o de ingest\u00e3o de alimentos). Essa triagem deve ser feita sempre nas primeiras 48 horas ap\u00f3s a admiss\u00e3o na unidade hospitalar3<\/a>.<\/p>\n

 <\/p>\n

Veja tamb\u00e9m: Quais s\u00e3o as necessidades nutricionais de pacientes com covid-19<\/a><\/p>\n

 <\/p>\n

O suporte nutricional<\/strong><\/h2>\n

Diagnosticada a desnutri\u00e7\u00e3o, os pacientes devem receber o suporte adequado para corrigir esse status, de prefer\u00eancia com o apoio de profissionais especializados.<\/p>\n

 <\/p>\n

De acordo com as diretrizes da Brazilian Society of Parenteral and Enteral Nutrition<\/em> (BRASPEN)3<\/a>, a via oral deve ser considerada a via preferencial para a nutri\u00e7\u00e3o. Suplementos nutricionais devem ser introduzidos sempre que a ingest\u00e3o energ\u00e9tica for inferior a 60% das necessidades nutricionais.<\/strong><\/p>\n

 <\/p>\n

Em pacientes graves, a via enteral \u00e9 a preferencial. Ela deve ser introduzida nas primeiras 24 ou 48 horas. Caso tanto a nutri\u00e7\u00e3o oral e a parenteral sejam contraindicadas, a op\u00e7\u00e3o \u00e9 a nutri\u00e7\u00e3o parenteral. Al\u00e9m disso, ela \u00e9 indicada sempre que o paciente permane\u00e7a de 5 a 7 dias sem conseguir atingir aporte cal\u00f3rico adequada por via digestiva3<\/a>.<\/p>\n

 <\/p>\n

Segundo diretrizes da American Society for Parenteral and Enteral Nutrition<\/em> (ASPEN)4<\/a>, uma f\u00f3rmula padr\u00e3o com alto aporte proteico (superior a 20% de prote\u00ednas) deve ser considerada para as fases iniciais dos quadros agudos. No sentido oposto, devem ser evitadas f\u00f3rmulas com alto teor lip\u00eddico em pacientes cr\u00edticos com disfun\u00e7\u00e3o pulmonar3<\/a>.<\/p>\n

 <\/p>\n

A todo o momento, os pacientes devem ser monitorados para evitar complica\u00e7\u00f5es<\/strong> relacionadas \u00e0 nutri\u00e7\u00e3o enteral ou parenteral. A BRASPEN3<\/a>\u00a0recomenda o monitoramento do f\u00f3sforo s\u00e9rico, j\u00e1 que a defici\u00eancia desse elemento pode indicar s\u00edndrome de realimenta\u00e7\u00e3o e retardar a retirada do suporte ventilat\u00f3rio.<\/p>\n

 <\/p>\n

No mais, devem ser tomados os cuidados necess\u00e1rios para oferta do suporte nutricional nos pacientes pronados<\/strong>. Entre as principais recomenda\u00e7\u00f5es est\u00e3o a manuten\u00e7\u00e3o da cabe\u00e7a elevada (Trendelemburg Reverso) e iniciar e retirar a dieta sempre 1 hora antes do manejo da posi\u00e7\u00e3o3<\/a>.<\/p>\n

 <\/p>\n

O p\u00f3s-covid<\/strong><\/h2>\n

S\u00e3o frequentes as queixas de disfagia em pacientes que passaram por longos per\u00edodos de entuba\u00e7\u00e3o. Ou seja, mesmo ap\u00f3s melhora da condi\u00e7\u00e3o cl\u00ednica relacionada \u00e0 infec\u00e7\u00e3o pelo Sars-cov-2, eles ainda podem apresentar defici\u00eancias nutricionais devido \u00e0 ingest\u00e3o inadequada de nutrientes gerada pela dificuldade de engolir7<\/a>.<\/p>\n

 <\/p>\n

Nesses casos, novamente de acordo com a ESPEN1<\/a>, ap\u00f3s a extuba\u00e7\u00e3o deve ser considerada a oferta de alimentos com a textura adequada, que facilite a ingest\u00e3o<\/strong>. Por outro lado, caso isso se mostre inseguro, pode-se recorrer mais uma vez a nutri\u00e7\u00e3o enteral. Se houver alto risco de aspira\u00e7\u00e3o, nutri\u00e7\u00e3o enteral via p\u00f3s-pil\u00f3rica ou mesmo a nutri\u00e7\u00e3o parenteral s\u00e3o recomendadas.<\/p>\n

 <\/p>\n

Entre pacientes mais idosos, a dificuldade para engolir ap\u00f3s a fase aguda da doen\u00e7a pode se estender por intervalos superiores a 21 dias ap\u00f3s longos per\u00edodos de intuba\u00e7\u00e3o. Em quadros extremos, disfagias graves est\u00e3o relacionadas com desfechos piores, incluindo pneumonias, reintuba\u00e7\u00e3o e maiores taxas de mortalidade5<\/a>,6<\/a><\/sup>. <\/strong>Portanto, tal condi\u00e7\u00e3o deve ser acompanhada com a aten\u00e7\u00e3o necess\u00e1ria.<\/p>\n

 <\/p>\n

Uma vez que o impacto da desnutri\u00e7\u00e3o \u00e9 significativo entre pacientes com quadros graves de covid-19, a evolu\u00e7\u00e3o nas formas de manejo e o aprimoramento das diretrizes certamente se converte em melhorias nos desfechos cl\u00ednicos. Logo, aprender com a evolu\u00e7\u00e3o do cuidado nessas situa\u00e7\u00f5es faz toda a diferen\u00e7a, principalmente quando consideramos todo o aprendizado obtido ao longo da pandemia.<\/p>\n

 <\/p>\n

Saiba mais sobre nutri\u00e7\u00e3o parenteral consultando nossa se\u00e7\u00e3o sobre o assunto aqui no site.<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Em pacientes com covid-19 que desenvolvem sua forma mais grave e que s\u00e3o admitidos em ambiente hospitalar ou mesmo unidades de terapia intensiva, a terapia nutricional \u00e9 parte essencial do cuidado e do suporte oferecido na aten\u00e7\u00e3o aos pacientes em quadros cr\u00edticos3.   Ou seja, a nutri\u00e7\u00e3o cl\u00ednica adequada est\u00e1 entre uma das medidas de […]<\/p>\n","protected":false},"author":67,"featured_media":1611,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[41,5],"tags":[65,70,81,76,67],"class_list":["post-1855","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigo","category-desnutricao-relacionada-a-doenca","tag-covid-19","tag-desnutricao","tag-nutricao-clinica","tag-nutricao-enteral","tag-nutricao-parenteral"],"acf":[],"yoast_head":"\nComo lidar com as defici\u00eancias nutricionais de pacientes com 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