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2007, Número 2

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Med Crit 2007; 21 (2)


Apoyo nutricional en el enfermo crítico: Experiencia de 5 cohortes en 20 años

Álvarez MP, Cerón DUW, Sierra UA

Idioma: Español
Referencias bibliográficas: 40
Paginas: 80-90
Archivo PDF: 94.23 Kb.


RESUMEN

Objetivo: Identificar las características del enfermo crítico con apoyo nutricional, determinar la influencia del apoyo en la mortalidad y comparar los resultados con datos previos de la unidad.
Diseño: Estudio retrospectivo, comparativo.
Lugar: Unidad de Terapia Intensiva de un hospital de enseñanza.
Enfermos: Pacientes ingresados a la Unidad en el periodo de 2004. Se excluyen registros incompletos y para el análisis de mortalidad se excluyen reingresos, altas a otro hospital, menores de 18 años, enfermos coronarios, cirugía de corazón y quemados.
Intervenciones: Ninguna.
Métodos: Se compara la diferencia entre grupos con t de Student y χ², se realiza análisis de varianza con prueba de Dunnet. Se compara mortalidad hospitalaria observada vs esperada por APACHE II usando el SMR (Standarized Mortality Ratio) con intervalo de confianza (IC) de 95%.
Resultados principales: De 428 pacientes ingresados a la UTI en 2004 se incluyeron 358, de los cuales se nutrieron artificialmente 183 (51%), 150 por vía enteral (82%), 16 por vía parenteral (8.7%), y 17 en forma mixta (9.3%). No hubo diferencia entre nutridos y no nutridos en edad (p = 0.74), sexo (p = 0.91), APACHE II (p = 0.44) y SDOM (p = 0.95). La mortalidad observada vs esperada fue para parenteral 28.6 vs 28.8%, SMR 0.99 (IC 95%: 0.27 a 2.53); enteral 14.8 vs 20.8%, 0.71 (0.42 a 1.127); mixta 23.1 vs 32.6%, 0.7 (0.14 a 2.06); nutridos total 16.8 vs 22.4%, 0.74 (0.48 a 1.1); no nutridos 23.5 vs 26.7%, 0.93 (0.65 a 1.29).
Conclusión: Hay una tendencia a disminución de la mortalidad en los pacientes que recibieron nutrición enteral y el total de nutridos artificialmente. Existe un aumento en la cantidad de pacientes nutridos por vía enteral y el total de pacientes con soporte nutricional en comparación con años previos y una disminución en la mortalidad en dichos grupos.


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