Efeitos da administração de fluidos intravenosos na infusão de dieta enteral em pacientes críticos : uma coorte prospectiva

Abstract

Intravenous fluids is the first choice and doctrine for resuscitation critical ill shock patients in hemodynamic instability. This liberal supply of fluids may results in edema and organ failure. Many patients require enteral nutrition therapy, however not all prescribed is infused. About 60-70% of enteral diets prescribed is administered. The caloric and protein deficts is caused by several gastrointestinal desordens. Objective: Evaluate the effects of intravenous fluids administration at enteral nutrition infusion. Methods: A prospectve cohort study with 86 critically ill clinical patients admitted to two intensive care units, general ICU (65.1%) and coronary (34.9%), median age 68 years, 45.3% male and 54.7% female. The patients were at least five days at ICU, in mechanical ventilation and exclusive enteral therapy. The primary outcome was the amount of fluids administered intravenously at the first day and five consecutives days, volume of enteral diet infused in five days and per kilogram of body weight, percent of enteral diet infused, nutritional status and serum albumin. Results: The median of fluids/kg administation was 41.6 (17.0-88.2) ml/kg and 75% of patientes, received more than 30ml/kg body weight of fluids. The mean infusion of enteral diet in the five consecutives days was 67%±19.8%. Patients who received an infusion of fluids on the first day >35 ml/kg, considering the first 28 days of hospitalization, received less enteral diet per day (495.9±49.22 vs 713.6±80.8; p=0.02). Administration of intravenous fluids on the first day, showed a negative correlation with the infusion of enteral diet per day (R=-0.25; p=0.01) and serum albumin (R= -0.30; p=0.006). Patients who received more enteral diet, also showed a higher serum albumin (R= 0.28; p= 0.01). Malnourished patients also received more intravenous fluids (50.0±3.9 vs 41.0±1.9 ml/kg; p=0.02) than non malnourished. Conclusion: The high infusion of fluids on the first day in ICU, results in less infusion of enteral nutrition and had a negative correlation with enteral diet and serum albumin levels.