{"id":1919,"date":"2023-06-28T10:19:45","date_gmt":"2023-06-28T13:19:45","guid":{"rendered":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?p=1919"},"modified":"2023-08-09T14:58:51","modified_gmt":"2023-08-09T17:58:51","slug":"nutricao-parenteral-sepse","status":"publish","type":"post","link":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/","title":{"rendered":"O que \u00e9 preciso considerar na introdu\u00e7\u00e3o da nutri\u00e7\u00e3o parenteral em pacientes com sepse?"},"content":{"rendered":"<p>Estima-se que anualmente mais de 18 milh\u00f5es de pessoas desenvolvem sepse e mais de 5 milh\u00f5es podem ir a \u00f3bito no mundo todo<sup> 1-3<\/sup>. Assim, em m\u00e9dia, a sepse e o choque s\u00e9ptico matam entre um ter\u00e7o e um sexto dos pacientes acometidos<sup>4<\/sup>. Isso faz desse problema de sa\u00fade uma das maiores causas de morte por infec\u00e7\u00e3o ao redor do planeta. <strong>Dessa forma, o suporte da nutri\u00e7\u00e3o parenteral em pacientes com sepse contribui com o manejo adequado da condi\u00e7\u00e3o, principalmente no ambiente de terapia intensiva.<\/strong><\/p>\n<p>A introdu\u00e7\u00e3o adequada desse recurso terap\u00eautico contribui para aumentar a chance de desfechos positivos diante do cen\u00e1rio de mudan\u00e7a metab\u00f3lica imposto pela doen\u00e7a. Assim sendo, isso sempre deve levar em conta as diretrizes baseadas nas melhores evid\u00eancias dispon\u00edveis.<\/p>\n<p>&nbsp;<\/p>\n<h2>Sepse: evolu\u00e7\u00e3o, sintomas e diagn\u00f3stico<\/h2>\n<p>Em resumo, <strong>a sepse \u00e9 uma condi\u00e7\u00e3o definida pela amea\u00e7a provocada pela resposta desregulada do organismo diante de um quadro infeccioso desencadeado por um microrganismo<sup>5<\/sup> (em especial bact\u00e9rias e mais raramente fungos<\/strong>). Adicionalmente, um choque s\u00e9ptico \u00e9 o quadro derivado da sepse, no qual o grau das disfun\u00e7\u00f5es metab\u00f3licas e circulat\u00f3rias \u00e9 ainda mais acentuado, elevando o risco de morte<sup>5<\/sup>.<\/p>\n<p>Normalmente, o organismo \u00e9 capaz de modular de forma muito eficiente toda a resposta imune diante de uma s\u00e9rie de agentes nocivos.<strong> Todavia, \u00e0s vezes, a desregula\u00e7\u00e3o na libera\u00e7\u00e3o de uma s\u00e9rie de marcadores inflamat\u00f3rios, citocinas e outras mol\u00e9culas desencadeiam uma s\u00e9rie de mecanismos que podem provocar danos a diferentes tecidos do organismo, em especial \u00e0queles compostos por c\u00e9lulas endoteliais<\/strong><sup>6,7<\/sup>.<\/p>\n<p>Assim, em um primeiro momento, o paciente pode apresentar aumento no d\u00e9bito card\u00edaco e a forma\u00e7\u00e3o de microtrombos nas art\u00e9rias. Com isso, h\u00e1 uma redu\u00e7\u00e3o na perfus\u00e3o de diferentes partes do organismo. Isso pode estar associado a quadros de coagulopatia, resultado do esgotamento dos fatores de coagula\u00e7\u00e3o<sup>7<\/sup>.<\/p>\n<p>A suspeita de sepse acontece a partir do momento que um paciente com quadro infeccioso apresenta sintomas de disfun\u00e7\u00e3o da atividade de diferentes \u00f3rg\u00e3os ou de uma manifesta\u00e7\u00e3o inflamat\u00f3ria sist\u00eamica. <strong>Com o prop\u00f3sito de confirmar o diagn\u00f3stico, s\u00e3o utilizados escores como o SOFA (escala para avalia\u00e7\u00e3o do avan\u00e7o na fal\u00eancia dos \u00f3rg\u00e3os)<sup>5<\/sup>.<\/strong><\/p>\n<p>&nbsp;<\/p>\n<h2>A necessidade da nutri\u00e7\u00e3o parenteral em pacientes com sepse<\/h2>\n<p><strong>O desenvolvimento do quadro de sepse leva o paciente a um quadro de estresse metab\u00f3lico<\/strong>. Ele piora a partir do momento que o paciente deixa de compensar o aporte nutricional de forma adequada<sup>8<\/sup>. <strong>Por isso s\u00e3o comuns disfun\u00e7\u00f5es que provocam altera\u00e7\u00f5es na forma como o organismo processa uma s\u00e9rie de nutrientes. Com isso pode haver, entre outras altera\u00e7\u00f5es<sup>9<\/sup><\/strong>:<\/p>\n<ul>\n<li>hiperglicemia relacionada ao estresse;<\/li>\n<li>s\u00edntese de glicog\u00eanio aumentada;<\/li>\n<li>diminui\u00e7\u00e3o da massa muscular;<\/li>\n<li>catabolismo proteico;<\/li>\n<li>estresse oxidativo (em especial lip\u00eddico).<\/li>\n<\/ul>\n<p>Desse modo, \u00e9 recomendado que todos os pacientes atravessando um quadro de sepse tenham seu quadro metab\u00f3lico avaliado, assim como seu estado nutricional. Essas avalia\u00e7\u00f5es devem ser realizadas considerando o risco de hipo ou hipernutri\u00e7\u00e3o<sup>8<\/sup>. Com isso, \u00e9 poss\u00edvel verificar a necessidade de suporte nutricional pelas vias dispon\u00edveis.<\/p>\n<p>Normalmente, <strong>pacientes com sepse n\u00e3o apresentam disponibilidade da via oral, seja pela depend\u00eancia do suporte respirat\u00f3rio a partir da admiss\u00e3o na UTI, seja por conta de problemas para, mastigar ou engolir. <\/strong><\/p>\n<p>Logo, a recomenda\u00e7\u00e3o \u00e9 de que os pacientes tenham suporte da nutri\u00e7\u00e3o enteral. Todavia, sempre que tal medida n\u00e3o for capaz de garantir o aporte nutricional adequado, ou n\u00e3o for vi\u00e1vel, a nutri\u00e7\u00e3o parenteral \u00e9 uma alternativa que pode ser aproveitada com seguran\u00e7a e efic\u00e1cia, conforme sustentam as diretrizes para pacientes cr\u00edticos<sup>10<\/sup>.<\/p>\n<p>&nbsp;<\/p>\n<p><em>Leia tamb\u00e9m: <\/em><a href=\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/indicacao-nutricao-parenteral\/\"><em>O que voc\u00ea precisa saber sobre a nutri\u00e7\u00e3o parenteral<\/em><\/a><\/p>\n<p>&nbsp;<\/p>\n<h2>Cuidados para a preven\u00e7\u00e3o de complica\u00e7\u00f5es adicionais<\/h2>\n<p><strong>\u00c9 recomendado que pacientes na fase aguda do quadro de sepse n\u00e3o recebam aportes superiores a 20 kcal\/kg\/dia<sup>9<\/sup><\/strong>. Uma vez que alguma evolu\u00e7\u00e3o positiva \u00e9 percebida, torna-se poss\u00edvel alcan\u00e7ar par\u00e2metros como<sup>9<\/sup>:<\/p>\n<ul>\n<li>ingest\u00e3o cal\u00f3rica entre 25-30 kcal\/kg\/dia (compostas por dois ter\u00e7os de carboidratos e um ter\u00e7o de gorduras);<\/li>\n<li>aporte proteico entre 1,2-1,5 g\/kg\/dia.<\/li>\n<\/ul>\n<p>Os profissionais respons\u00e1veis pelo acompanhamento do paciente devem sempre avaliar a necessidade do fornecimento de determinados <a href=\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/importancia-dos-micronutrientes-nutricao-parenteral\/\">micronutrientes<\/a>. <a href=\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/diferentes-aminoacidos-nutricao-parenteral\/\">Amino\u00e1cidos<\/a> como a glutamina podem contribuir com uma maior chance de desfecho positivo, desde que administrados de forma adequada<sup>8<\/sup>. No mais, <strong>\u00e9 preciso sempre ressaltar que o paciente deve ser devidamente monitorado e a dieta ajustada conforme s\u00e3o percebidas mudan\u00e7as no comportamento ou na composi\u00e7\u00e3o corporal<sup>9<\/sup>.<\/strong><\/p>\n<p><strong>A partir das evid\u00eancias dispon\u00edveis os pacientes com sepse parecem se beneficiar do uso de f\u00f3rmulas com emuls\u00f5es lip\u00eddicas de <\/strong><a href=\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/oleo-de-peixe-e-seu-papel-nutricional-no-paciente-critico\/\"><strong>\u00f3leo de peixe.<\/strong><\/a> Uma <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9185164\/pdf\/tkac012.pdf\">revis\u00e3o de literatura publicada em 2022<\/a> analisou os dados de 25 estudos cl\u00ednicos e concluiu que a ado\u00e7\u00e3o dessa gordura reduziu a mortalidade, o tempo de perman\u00eancia na UTI e a necessidade de suporte de ventila\u00e7\u00e3o mec\u00e2nica<sup>11<\/sup>.<\/p>\n<p>Por outro lado, <strong>entre contraindica\u00e7\u00f5es fundamentais para a nutri\u00e7\u00e3o parenteral em pacientes com sepse est\u00e3o a instabilidade hemodin\u00e2mica e a presen\u00e7a de sinais de choque s\u00e9ptico<\/strong><sup>8<\/sup>. Ou seja: \u00e9 necess\u00e1rio aguardar a recomposi\u00e7\u00e3o da perfus\u00e3o tecidual para introduzir a terapia nutricional, seja ela enteral ou parenteral<sup>8<\/sup>.<\/p>\n<p>&nbsp;<\/p>\n<p>Aproveite para compreender melhor de que forma deve se dar a <a href=\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/calorias-e-proteinas\/\">rela\u00e7\u00e3o entre calorias e prote\u00ednas na nutri\u00e7\u00e3o parenteral.<\/a><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h2><strong>Refer\u00eancias<\/strong><\/h2>\n<ol>\n<li>SILVA, EL; CESAR, JJ. Hematologic changes related to sepsis in patients admitted to the intensive care unit. Brazilian Journal of Surgery and Clinical Research. 2019. Dispon\u00edvel em: <a href=\"https:\/\/www.mastereditora.com.br\/periodico\/20190306_114904.pdf\">https:\/\/www.mastereditora.com.br\/periodico\/20190306_114904.pdf<\/a>. Acesso em maio de 2023.<\/li>\n<li>ABUBAKAR, I. I.; TILLMANN, Taavi; BANERJEE, Amitava. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, v. 385, n. 9963, p. 117-171, 2015. Dispon\u00edvel em: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4340604\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4340604\/<\/a>. Acesso em maio de 2023.<\/li>\n<li>TILLMANN, Bourke; WUNSCH, Hannah. Epidemiology and outcomes. Critical Care Clinics, v. 34, n. 1, p. 15-27, 2018.<\/li>\n<li>EVANS, Laura et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive care medicine, v. 47, n. 11, p. 1181-1247, 2021. Dispon\u00edvel em: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8486643\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8486643\/<\/a>. Acesso em maio de 2023.<\/li>\n<li>SINGER, Mervyn et al. The third international consensus definitions for sepsis and septic hock (Sepsis-3). Jama, v. 315, n. 8, p. 801-810, 2016. Dispon\u00edvel em: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4968574\/pdf\/nihms794087.pdf\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4968574\/pdf\/nihms794087.pdf<\/a>. Acesso em maio de 2023.<\/li>\n<li>CHOUSTERMAN BG;\u00a0SWIRSKI, Filip K.; WEBER, Georg F. Cytokine storm and sepsis disease pathogenesis. In: Seminars in immunopathology. Springer Berlin Heidelberg, 2017. p. 517-528.<\/li>\n<li>FORRESTER, J. D. Sepse e choque s\u00e9ptico. Manuais MSD. Dispon\u00edvel em: https:\/\/www.msdmanuals.com\/pt-br\/profissional\/medicina-de-cuidados-cr%C3%ADticos\/sepse-e-choque-s%C3%A9ptico\/sepse-e-choque-s%C3%A9pticO. Acesso em maio de 2023.<\/li>\n<li>COSTA FILHO, RC et al.. 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. Dispon\u00edvel em: https:\/\/amb.org.br\/files\/ans\/sepse-nutricao.pdf. Acesso em maio de 2023<\/li>\n<li>LHEUREUX, Olivier; PREISER, Jean\u2010Charles. Role of nutrition support in inflammatory conditions. Nutrition in clinical practice, v. 32, n. 3, p. 310-317, 2017.<\/li>\n<li>SINGER, Pierre et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical nutrition, v. 38, n. 1, p. 48-79, 2019. Dispon\u00edvel em: <a href=\"https:\/\/www.espen.org\/files\/ESPEN-Guidelines\/ESPEN_guideline-on-clinical-nutrition-in-the-intensive-care-unit.pdf\">https:\/\/www.espen.org\/files\/ESPEN-Guidelines\/ESPEN_guideline-on-clinical-nutrition-in-the-intensive-care-unit.pdf<\/a>. Acesso em maio de 2023.<\/li>\n<li>WANG, Hongyu et al. Effects of fish oil-containing nutrition supplementation in adult sepsis patients: a systematic review and meta-analysis. Burns &amp; Trauma, v. 10, 2022. Dispon\u00edvel em: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9185164\/pdf\/tkac012.pdf\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9185164\/pdf\/tkac012.pdf<\/a>. Acesso em maio de 2023.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Estima-se que anualmente mais de 18 milh\u00f5es de pessoas desenvolvem sepse e mais de 5 milh\u00f5es podem ir a \u00f3bito no mundo todo 1-3. Assim, em m\u00e9dia, a sepse e o choque s\u00e9ptico matam entre um ter\u00e7o e um sexto dos pacientes acometidos4. Isso faz desse problema de sa\u00fade uma das maiores causas de morte [&hellip;]<\/p>\n","protected":false},"author":5902,"featured_media":1920,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[49],"tags":[233,81,67,232,195],"class_list":["post-1919","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigo-5","tag-choque-septico","tag-nutricao-clinica","tag-nutricao-parenteral","tag-sepse","tag-terapia-intensiva"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Quando a nutri\u00e7\u00e3o parenteral em pacientes com sepse \u00e9 indicada?<\/title>\n<meta name=\"description\" content=\"A nutri\u00e7\u00e3o parenteral em pacientes com sepse pode fazer parte do suporte oferecido para garantir uma chance maior de um desfecho positivo\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Quando a nutri\u00e7\u00e3o parenteral em pacientes com sepse \u00e9 indicada?\" \/>\n<meta property=\"og:description\" content=\"A nutri\u00e7\u00e3o parenteral em pacientes com sepse pode fazer parte do suporte oferecido para garantir uma chance maior de um desfecho positivo\" \/>\n<meta property=\"og:url\" content=\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/\" \/>\n<meta property=\"og:site_name\" content=\"Unidos pela Nutri\u00e7\u00e3o Cl\u00ednica | Brasil\" \/>\n<meta property=\"article:published_time\" content=\"2023-06-28T13:19:45+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-08-09T17:58:51+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2023\/06\/663-3733-4601x3071-1-scaled.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"2560\" \/>\n\t<meta property=\"og:image:height\" content=\"1709\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Social Media\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Social Media\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. tempo de leitura\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/\"},\"author\":{\"name\":\"Social Media\",\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#\/schema\/person\/17b9f84d3d796836a73304aa1556707e\"},\"headline\":\"O que \u00e9 preciso considerar na introdu\u00e7\u00e3o da nutri\u00e7\u00e3o parenteral em pacientes com sepse?\",\"datePublished\":\"2023-06-28T13:19:45+00:00\",\"dateModified\":\"2023-08-09T17:58:51+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/\"},\"wordCount\":1344,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#organization\"},\"image\":{\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2023\/06\/663-3733-4601x3071-1-scaled.jpg\",\"keywords\":[\"choque s\u00e9ptico\",\"nutri\u00e7\u00e3o cl\u00ednica\",\"nutri\u00e7\u00e3o parenteral\",\"sepse\",\"terapia intensiva\"],\"articleSection\":[\"Artigos\"],\"inLanguage\":\"pt-BR\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/\",\"url\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/\",\"name\":\"Quando a nutri\u00e7\u00e3o parenteral em pacientes com sepse \u00e9 indicada?\",\"isPartOf\":{\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2023\/06\/663-3733-4601x3071-1-scaled.jpg\",\"datePublished\":\"2023-06-28T13:19:45+00:00\",\"dateModified\":\"2023-08-09T17:58:51+00:00\",\"description\":\"A nutri\u00e7\u00e3o parenteral em pacientes com sepse pode fazer parte do suporte oferecido para garantir uma chance maior de um desfecho positivo\",\"breadcrumb\":{\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#breadcrumb\"},\"inLanguage\":\"pt-BR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"pt-BR\",\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#primaryimage\",\"url\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2023\/06\/663-3733-4601x3071-1-scaled.jpg\",\"contentUrl\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2023\/06\/663-3733-4601x3071-1-scaled.jpg\",\"width\":2560,\"height\":1709},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"O que \u00e9 preciso considerar na introdu\u00e7\u00e3o da nutri\u00e7\u00e3o parenteral em pacientes com sepse?\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#website\",\"url\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/\",\"name\":\"Unidos pela Nutri\u00e7\u00e3o Cl\u00ednica | Brasil\",\"description\":\"\u00c9 uma iniciativa criada pela Fresenius Kabi para ajudar aos profissionais de sa\u00fade.\",\"publisher\":{\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"pt-BR\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#organization\",\"name\":\"Fresenius Kabi AG\",\"url\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"pt-BR\",\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2018\/06\/Downloads_en_0001_Logo_edit_portugues.jpg\",\"contentUrl\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2018\/06\/Downloads_en_0001_Logo_edit_portugues.jpg\",\"width\":600,\"height\":400,\"caption\":\"Fresenius Kabi AG\"},\"image\":{\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#\/schema\/logo\/image\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#\/schema\/person\/17b9f84d3d796836a73304aa1556707e\",\"name\":\"Social Media\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"pt-BR\",\"@id\":\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/b8883a7cf32d41bf519c4397727166e2?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/b8883a7cf32d41bf519c4397727166e2?s=96&d=mm&r=g\",\"caption\":\"Social Media\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Quando a nutri\u00e7\u00e3o parenteral em pacientes com sepse \u00e9 indicada?","description":"A nutri\u00e7\u00e3o parenteral em pacientes com sepse pode fazer parte do suporte oferecido para garantir uma chance maior de um desfecho positivo","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/","og_locale":"pt_BR","og_type":"article","og_title":"Quando a nutri\u00e7\u00e3o parenteral em pacientes com sepse \u00e9 indicada?","og_description":"A nutri\u00e7\u00e3o parenteral em pacientes com sepse pode fazer parte do suporte oferecido para garantir uma chance maior de um desfecho positivo","og_url":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/","og_site_name":"Unidos pela Nutri\u00e7\u00e3o Cl\u00ednica | Brasil","article_published_time":"2023-06-28T13:19:45+00:00","article_modified_time":"2023-08-09T17:58:51+00:00","og_image":[{"width":2560,"height":1709,"url":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2023\/06\/663-3733-4601x3071-1-scaled.jpg","type":"image\/jpeg"}],"author":"Social Media","twitter_card":"summary_large_image","twitter_misc":{"Escrito por":"Social Media","Est. tempo de leitura":"7 minutos"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#article","isPartOf":{"@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/"},"author":{"name":"Social Media","@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#\/schema\/person\/17b9f84d3d796836a73304aa1556707e"},"headline":"O que \u00e9 preciso considerar na introdu\u00e7\u00e3o da nutri\u00e7\u00e3o parenteral em pacientes com sepse?","datePublished":"2023-06-28T13:19:45+00:00","dateModified":"2023-08-09T17:58:51+00:00","mainEntityOfPage":{"@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/"},"wordCount":1344,"commentCount":0,"publisher":{"@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#organization"},"image":{"@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#primaryimage"},"thumbnailUrl":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2023\/06\/663-3733-4601x3071-1-scaled.jpg","keywords":["choque s\u00e9ptico","nutri\u00e7\u00e3o cl\u00ednica","nutri\u00e7\u00e3o parenteral","sepse","terapia intensiva"],"articleSection":["Artigos"],"inLanguage":"pt-BR","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/","url":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/","name":"Quando a nutri\u00e7\u00e3o parenteral em pacientes com sepse \u00e9 indicada?","isPartOf":{"@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#website"},"primaryImageOfPage":{"@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#primaryimage"},"image":{"@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#primaryimage"},"thumbnailUrl":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2023\/06\/663-3733-4601x3071-1-scaled.jpg","datePublished":"2023-06-28T13:19:45+00:00","dateModified":"2023-08-09T17:58:51+00:00","description":"A nutri\u00e7\u00e3o parenteral em pacientes com sepse pode fazer parte do suporte oferecido para garantir uma chance maior de um desfecho positivo","breadcrumb":{"@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#breadcrumb"},"inLanguage":"pt-BR","potentialAction":[{"@type":"ReadAction","target":["https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/"]}]},{"@type":"ImageObject","inLanguage":"pt-BR","@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#primaryimage","url":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2023\/06\/663-3733-4601x3071-1-scaled.jpg","contentUrl":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2023\/06\/663-3733-4601x3071-1-scaled.jpg","width":2560,"height":1709},{"@type":"BreadcrumbList","@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutricao-parenteral-sepse\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/"},{"@type":"ListItem","position":2,"name":"O que \u00e9 preciso considerar na introdu\u00e7\u00e3o da nutri\u00e7\u00e3o parenteral em pacientes com sepse?"}]},{"@type":"WebSite","@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#website","url":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/","name":"Unidos pela Nutri\u00e7\u00e3o Cl\u00ednica | Brasil","description":"\u00c9 uma iniciativa criada pela Fresenius Kabi para ajudar aos profissionais de sa\u00fade.","publisher":{"@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"pt-BR"},{"@type":"Organization","@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#organization","name":"Fresenius Kabi AG","url":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/","logo":{"@type":"ImageObject","inLanguage":"pt-BR","@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#\/schema\/logo\/image\/","url":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2018\/06\/Downloads_en_0001_Logo_edit_portugues.jpg","contentUrl":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2018\/06\/Downloads_en_0001_Logo_edit_portugues.jpg","width":600,"height":400,"caption":"Fresenius Kabi AG"},"image":{"@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#\/schema\/person\/17b9f84d3d796836a73304aa1556707e","name":"Social Media","image":{"@type":"ImageObject","inLanguage":"pt-BR","@id":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/b8883a7cf32d41bf519c4397727166e2?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b8883a7cf32d41bf519c4397727166e2?s=96&d=mm&r=g","caption":"Social Media"}}]}},"_links":{"self":[{"href":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-json\/wp\/v2\/posts\/1919","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-json\/wp\/v2\/users\/5902"}],"replies":[{"embeddable":true,"href":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-json\/wp\/v2\/comments?post=1919"}],"version-history":[{"count":0,"href":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-json\/wp\/v2\/posts\/1919\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-json\/wp\/v2\/media\/1920"}],"wp:attachment":[{"href":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-json\/wp\/v2\/media?parent=1919"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-json\/wp\/v2\/categories?post=1919"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-json\/wp\/v2\/tags?post=1919"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}