Resumo

JEREB, Silvia et al. Influence of gastroparesis on achieving the caloric and protein goal in neurocritical patients. Diaeta [online]. 2019, vol.37, n.166, pp.41-48. ISSN 1852-7337.

The brain injury induces the appearance of gastrointestinal complications, especially gastroparesis, which is considered one of the pillars of high digestive intolerance. It is measured by the increase in gastric residue, gastroesophageal reflux, vomiting, abdominal distension and / or diarrhea. As a consequence, enteral nutrition (EN) begins late or inefficiently, preventing the caloric-protein goal from being achieved, increasing the risk of aspiration pneumonia, prolonging the hospital stay and increasing mortality. A literature review was carried out with the objective of updating and describing the role of gastroparesis in the scope of the caloric-protein goal in the neurocritical patient. Electronic databases were consulted: MEDLINE, EMBASE, LILACS, Cochrane, from 2007 to 2017. 8 studies were included, four randomized controlled trials (RCTs), two observational studies and two systematic reviews and meta-analyzes. In three RCTs when the EN is post-pyloric, a greater caloric and protein intake is achieved. Two studies found no difference in the calories received between patients fed via stomach or jejunum. Two reviews and meta-analyzes confirm a lower risk of aspiration pneumonia, but there are no differences in the percentage of adaptation to the EN by both routes. Mortality, days of mechanical ventilation, stay in the intensive care unit (ICU) and hospital stay were not different when the EN was via stomach or intestine. In conclusion, the persistence of delayed gastric emptying favors protein and energy deficit, due to intolerance to EN, which hinders progression. To date, few studies recommend the postpyloric route to improve nutritional efficiency. Future studies should evaluate the implications of reaching the caloric-protein goal in clinical results according to the EN route, in this patient population.

Palavras-chave : Palliative care; Oncological patient; Advanced cancer; Alimentary characteristics.

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