Impacto do tipo de terapia nutricional na sobrevida de pacientes críticos desnutridos com hipofosfatemia

Abstract

Either prolonged fasting or malnourished critically ill patients usually have hypophosphatemia and are most prone to develop to refeeding syndrome. Objective: To investigate the influence of the type of nutritional therapy (NT) on the survival of critically ill malnourished patients with hypophosphatemia. Method: Retrospective cohort study including 468 patients admitted at the ICU of a tertiary hospital in Cuiabá-MT. It was compared the values of serum phosphorus at admission (P1) and after the initiation of NT (P2) focusing on the frequency of hypophosphatemia (phosphorus <2.5mg / dl) at P1 and P2. The probability of survival in the ICU was investigated according to the type of NT received during hospitalization: enteral nutrition (EN) or EN supplemented nutrition (SEN) in the presence of hypophosphatemia seen at both P1 and P2. The nutritional status was obtained through subjective global assessment. Results: We observed an increased frequency of cases with hypophosphatemia from P1 to P2 in global analysis. However this increase occurred only in patients receiving EN exclusively (p<0.01). The cumulated survival probability was lower for patients with hypophosphatemia who received NE at both P1 (22.4 vs 59.7%, log-rank p=0.001) and P2 (37.4 vs 31.1%, p =0.041 log-rank) when compared to those receiving SEN. Conclusion: SEN increases survival probability over sole EN in malnourished critically with hypophosphatemia.