{"id":1919,"date":"2026-07-15T09:00:45","date_gmt":"2026-07-15T12:00:45","guid":{"rendered":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?p=1919"},"modified":"2026-07-15T10:33:42","modified_gmt":"2026-07-15T13:33:42","slug":"nutricao-parenteral-na-sepse","status":"publish","type":"post","link":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-na-sepse\/","title":{"rendered":"Nutri\u00e7\u00e3o parenteral pode ser indicada para o paciente com sepse?"},"content":{"rendered":"

A sepse \u00e9 uma condi\u00e7\u00e3o cl\u00ednica grave e complexa, caracterizada por resposta inflamat\u00f3ria sist\u00eamica e desregulada a uma infec\u00e7\u00e3o, com disfun\u00e7\u00f5es org\u00e2nicas que geram risco de vida. Trata-se de um dos maiores desafios enfrentados nas UTIs, sendo uma das principais causas de mortalidade em ambientes hospitalares cr\u00edticos (1, 2).<\/p>\n

O manejo nutricional na sepse exige uma abordagem cuidadosa e especializada. Nestes pacientes, a nutri\u00e7\u00e3o n\u00e3o \u00e9 apenas uma fonte de sustenta\u00e7\u00e3o energ\u00e9tica, mas tamb\u00e9m um meio de modula\u00e7\u00e3o da resposta imune e suporte \u00e0 recupera\u00e7\u00e3o org\u00e2nica<\/strong> (1).<\/p>\n

Para explorar a aplicabilidade da nutri\u00e7\u00e3o parenteral, \u00e9 importante entender quando e em que condi\u00e7\u00f5es ela se faz necess\u00e1ria. Confira a seguir.<\/p>\n

Fisiopatologia da sepse<\/h2>\n

A disfun\u00e7\u00e3o multiorg\u00e2nica<\/strong> induzida por sepse \u00e9 marcada por altera\u00e7\u00f5es fisiol\u00f3gicas progressivas em diferentes \u00f3rg\u00e3os, podendo variar de forma leve at\u00e9 quadros graves e irrevers\u00edveis. Os sistemas cardiovascular e respirat\u00f3rio<\/strong> s\u00e3o os mais frequentemente afetados (2).<\/p>\n

Fisiopatologicamente, a sepse costuma evoluir de um estado inicial de inflama\u00e7\u00e3o sist\u00eamica e hipermetabolismo para uma fase prolongada de imunossupress\u00e3o, com apoptose de linf\u00f3citos e redu\u00e7\u00e3o da atividade pr\u00f3-inflamat\u00f3ria de mon\u00f3citos e macr\u00f3fagos (2).<\/p>\n

Esse quadro leva a um estado de catabolismo proteico cont\u00ednuo, com perda de massa muscular, fal\u00eancia org\u00e2nica persistente, fraqueza neuromuscular, caquexia, m\u00e1 cicatriza\u00e7\u00e3o, infec\u00e7\u00f5es secund\u00e1rias e decl\u00ednio cognitivo \u2014 um conjunto conhecido como s\u00edndrome de inflama\u00e7\u00e3o, imunossupress\u00e3o e catabolismo persistente (PICS)<\/strong> (2).<\/p>\n

H\u00e1 indica\u00e7\u00e3o de nutri\u00e7\u00e3o parenteral na sepse?<\/h2>\n

Sim. Quando a nutri\u00e7\u00e3o enteral \u00e9 impratic\u00e1vel ou insuficiente, a nutri\u00e7\u00e3o parenteral surge como um aspecto crucial do manejo terap\u00eautico (1).<\/p>\n

Momento de in\u00edcio e aporte energ\u00e9tico<\/h3>\n

O in\u00edcio da NP em pacientes com sepse ainda \u00e9 debatido. Embora a NP permita o atendimento completo das necessidades nutricionais, essa reposi\u00e7\u00e3o total nos primeiros dias pode n\u00e3o ser desej\u00e1vel (3).<\/p>\n

O catabolismo da sepse ativa mecanismos celulares, como a autofagia, que contribuem para a defesa imunol\u00f3gica e sobreviv\u00eancia celular. Assim, a introdu\u00e7\u00e3o precoce e agressiva de nutri\u00e7\u00e3o parenteral pode inibir mecanismos protetores e promover efeitos adversos <\/strong>(4).<\/p>\n

No estudo EPaNIC, o in\u00edcio tardio se associou a menor mortalidade, menor necessidade de ventila\u00e7\u00e3o e suporte renal, menor tempo de interna\u00e7\u00e3o e menos complica\u00e7\u00f5es infecciosas.<\/p>\n

Por outro lado, um maior aporte nutricional se associou a uma maior taxa de infec\u00e7\u00e3o e atraso na recupera\u00e7\u00e3o (2).<\/p>\n

Vale ressaltar que o estudo EPaNIC se baseou em c\u00e1lculos da taxa metab\u00f3lica, o que pode ter contribu\u00eddo para os efeitos negativos. Recomenda-se utilizar a calorimetria indireta como padr\u00e3o ouro <\/strong>(2).<\/p>\n

De qualquer forma, a NP deve ser considerada em qualquer paciente nos quais a NE n\u00e3o \u00e9 vi\u00e1vel ou \u00e9 insuficiente ap\u00f3s 3 dias<\/strong>, com aporte de aproximadamente de 50% das necessidades energ\u00e9ticas<\/strong> (3).<\/p>\n

 <\/p>\n

Recomenda\u00e7\u00f5es nutricionais na sepse<\/h3>\n

Assim como em qualquer paciente cr\u00edtico, o equil\u00edbrio adequado de nutrientes \u00e9 fundamental (1).<\/p>\n

A composi\u00e7\u00e3o correta de macros e micronutrientes pode influenciar positivamente os desfechos cl\u00ednicos em pacientes s\u00e9pticos, contribuindo para a melhora de sua condi\u00e7\u00e3o e, em alguns casos, at\u00e9 reduzindo a mortalidade (1).<\/p>\n

Na tabela abaixo, est\u00e3o descritas as recomenda\u00e7\u00f5es de nutrientes para pacientes s\u00e9pticos (2).<\/p>\n\n\n\n\n\n\n\n
Nutriente<\/strong><\/td>\nRecomenda\u00e7\u00e3o<\/strong><\/td>\n<\/tr>\n
Prote\u00edna<\/strong><\/td>\n0,8 g\/kg\/dia durante a sepse, e um aumento gradual at\u00e9 1,3 g\/kg\/dia ap\u00f3s a resolu\u00e7\u00e3o do choque<\/td>\n<\/tr>\n
Lip\u00eddios<\/strong><\/td>\n0,7 a 1,5 g\/kg\/dia<\/td>\n<\/tr>\n
Glucose<\/strong><\/td>\n1 a 1,5 g\/kg\/dia<\/td>\n<\/tr>\n
Flu\u00eddos<\/strong><\/td>\n1 mL\/kg\/h<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

De Waele et al., 2020.<\/em><\/p>\n

Uso de imunonutrientes<\/h3>\n

Nutrientes como \u00e1cidos graxos \u00f4mega-3, glutamina, arginina e nucleot\u00eddeos<\/strong>, t\u00eam sido estudados por seu potencial em (1):<\/p>\n

    \n
  • Melhorar a resposta imunol\u00f3gica<\/li>\n
  • Reduzir as respostas inflamat\u00f3rias prejudiciais<\/li>\n
  • Reduzir o estresse oxidativo<\/li>\n
  • Melhorar a integridade da barreira intestinal, prevenindo infec\u00e7\u00f5es secund\u00e1rias e complica\u00e7\u00f5es<\/li>\n<\/ul>\n

    Uma revis\u00e3o de literatura publicada em 2022 analisou os dados de 25 estudos cl\u00ednicos e concluiu que a ado\u00e7\u00e3o de emuls\u00f5es lip\u00eddicas de \u00f3leo de peixe reduziu a mortalidade, o tempo de perman\u00eancia na UTI e a necessidade de suporte de ventila\u00e7\u00e3o mec\u00e2nica em pacientes com sepse (5).<\/p>\n

    Seguran\u00e7a e efic\u00e1cia<\/h3>\n

    Enquanto a nutri\u00e7\u00e3o parenteral oferece benef\u00edcios significativos, tamb\u00e9m existem riscos associados. Assim, \u00e9 fundamental que a administra\u00e7\u00e3o de nutri\u00e7\u00e3o parenteral seja cuidadosamente monitorada ao longo do tratamento (1).<\/p>\n

    Entre contraindica\u00e7\u00f5es, est\u00e3o a instabilidade hemodin\u00e2mica e a presen\u00e7a de sinais de choque s\u00e9ptico<\/strong> (6). Ou seja: \u00e9 necess\u00e1rio aguardar a recomposi\u00e7\u00e3o da perfus\u00e3o tecidual para introduzir a terapia nutricional, seja ela enteral ou parenteral (6).<\/p>\n

    Conclus\u00e3o<\/h2>\n

    A nutri\u00e7\u00e3o parenteral, quando bem indicada e monitorada, pode ser uma aliada essencial no manejo da sepse. Seu uso deve considerar o estado cl\u00ednico do paciente, o momento adequado para in\u00edcio e o equil\u00edbrio cuidadoso de nutrientes.<\/p>\n

     <\/p>\n

    Refer\u00eancias<\/h2>\n
      \n
    1. Barbosa ES, Pimenta ACP, De Menezes ALF, Moura FMN, De Mello IGKA, Pinto MAF, da Paz Santos TL. Estrat\u00e9gias nutricionais parenterais no manejo da sepse: uma revis\u00e3o abrangente das pr\u00e1ticas atuais e potenciais inova\u00e7\u00f5es. Braz J Health Rev. 2024;7(1):1650-8.<\/li>\n
    2. De Waele E, Malbrain MLNG, Spapen H. Nutrition in Sepsis: A Bench-to-Bedside Review. Nutrients. 2020 Feb 2;12(2):395.<\/li>\n
    3. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, Hiesmayr M, Mayer K, Montejo JC, Pichard C, Preiser JC, van Zanten ARH, Oczkowski S, Szczeklik W, Bischoff SC. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019 Feb;38(1):48-79.<\/li>\n
    4. Van Niekerk G, Meaker C, Engelbrecht AM. Nutritional support in sepsis: when less may be more. Crit Care. 2020;24:53.<\/li>\n
    5. Wang H, Su S, Wang C, Hu J, Dan W, Peng X. Effects of fish oil-containing nutrition supplementation in adult sepsis patients: a systematic review and meta-analysis. Burns Trauma. 2022 Jun 10;10:tkac012. doi: 10.1093\/burnst\/tkac012. PMID: 35702267; PMCID: PMC9185164.<\/li>\n
    6. Costa Filho RC, Waitzberg DL, Calder PC, Machado FR. Sepse: Nutri\u00e7\u00e3o. Associa\u00e7\u00e3o de Medicina Intensiva Brasileira, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Nutri\u00e7\u00e3o Parenteral e Enteral, Instituto Latino Americano de Sepse. 2021.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

      A sepse \u00e9 uma condi\u00e7\u00e3o cl\u00ednica grave e complexa, caracterizada por resposta inflamat\u00f3ria sist\u00eamica e desregulada a uma infec\u00e7\u00e3o, com disfun\u00e7\u00f5es org\u00e2nicas que geram risco de vida. Trata-se de um dos maiores desafios enfrentados nas UTIs, sendo uma das principais causas de mortalidade em ambientes hospitalares cr\u00edticos (1, 2). O manejo nutricional na sepse exige […]<\/p>\n","protected":false},"author":5902,"featured_media":2138,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[49],"tags":[325,345,81,67,344,99,140,232,243,195,143,69],"class_list":["post-1919","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigo-5","tag-imunonutricao","tag-manejo-nutricional","tag-nutricao-clinica","tag-nutricao-parenteral","tag-nutricao-parenteral-na-sepse","tag-omega-3","tag-paciente-critico","tag-sepse","tag-suporte-nutricional","tag-terapia-intensiva","tag-terapia-nutricional","tag-uti"],"acf":[],"yoast_head":"\nNutri\u00e7\u00e3o Parenteral na Sepse: Quando Indicar, Quais os Cuidados?<\/title>\n<meta name=\"description\" content=\"Quando a nutri\u00e7\u00e3o parenteral \u00e9 indicada na sepse? 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