Monitoramento da espessura muscular do quadríceps por ultrassonografia em pacientes vasculares submetidos a jejum prolongado.

Abstract

Peripheral arterial disease (PAD) is a serious condition that affects about 202 million people worldwide. It is the third most common manifestation of atherosclerosis, after coronary artery disease (CAD) and stroke. Diabetes mellitus is an important risk factor for PAD and diabetic foot (DF), which can lead to limb amputations and high mortality. Many of these patients require hospitalization and surgical interventions. Preoperative fasting aims to reduce the risk of pulmonary aspiration during anesthetic induction, but it is often longer than recommended. The ACERTO Project proposes to shorten preoperative fasting by ingesting clear, residue-free liquids enriched with carbohydrates 2 hours before the procedure. On the other hand, malnutrition in hospitalized patients is a significant public health problem, with a prevalence of about 30% in hospitalized adult patients. Muscle loss is a risk factor for hospital complications, increased infection and mortality. The aim of the study was to evaluate the evolution of quadriceps muscle thickness using ultrasound as a nutritional marker in vascular patients requiring surgical procedures during hospitalization and its association with fasting time. A prospective cohort study was conducted at Risoleta Tolentino Neves Hospital in Belo Horizonte-MG, with patients with PAD or DF. Patients admitted to the Vascular Surgery Unit between April and November 2022 were selected. Patients were evaluated and Quadriceps Muscle Thickness (QMT) measured by ultrasound within 48 hours of admission, 7 days after admission, and at discharge. Data collection was completed with the recording of outcomes, fasting time and surgical cancellations. The study found a prolonged fasting time with a median of 17.5 hours and an accumulated fasting time of 27.4 ± 23.3 hours in surgical vascular patients, but there was no association with QMT evolution, wound, infection, ischemia and hospital outcomes. About 36% of patients reduced their quadriceps muscle mass by 10% or more in seven days. About 59% (20) of patients were malnourished on admission and QMT of malnourished patients was significantly lower compared to those without malnutrition (p<0.0001). This may justify the lack of differences at the three moments of the research, since quadriceps muscle thickness did not vary in surgical patients with PAD and DF, despite prolonged preoperative fasting. This study may be the beginning for the insertion of the fasting abbreviation protocol in the hospital.