Avaliação do estado nutricional do paciente gravemente enfermo

Abstract

Metabolic changes that occur in critically ill patients recquire special attention in use and interpretation of the various nutritional assessment methods. Current literature presents few data on the nutritional assessment of these patients, perhaps due to the difficulty in obtaining reliable data. However, even with these limitations it is not possible to perform safe and effective nutritional therapy, without prior nutritionalassessment. This study aimed at evaluating the nutritional status of critically ill patients using different nutritional assessment techniques. Subjective global assessment (SGA) was considered the "standard" for nutritional diagnosis and it was compared with the results of other methods (body mass index, arm circumference, triceps skinfold, arm muscle circumference, arm muscle area, calf circumference,albumin and total lymphocyte count). Data were analyzed for age, sex, race, APACHE II classification, underlying disease and patients outcome. The study enrolled 185 patients in the Hospital Felicio Rochos intensive care unit (ICU), from March 2009 to October 2010. The prevalence of malnutrition by SGA was 54%. Elderly patients, those who were less discharged from the ICU or those who returned to the ICU after discharge, were more likely to be malnouris ed. Furthermore, malnourished patients with more than 65 years, with clinical diseases, in mechanical ventilation and who returned to the ICU after discharge, presented with increased mortality. Agreement among all the different assessment tools was classified as poor or superficial. However, if different cut off points were used, they might be useful.