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Vol. 59. Issue 1.
Pages 19-24 (1 July 2003)
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Vol. 59. Issue 1.
Pages 19-24 (1 July 2003)
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Nutrición enteral transpilórica en el niño críticamente enfermo (I): técnica e indicaciones
Transpyloric enteral nutrition in critically-ill children (I): Technic and indications
Visits
16323
C. Sánchez Sáncheza, J. López-Herce Cid
,a
, A. Carrillo Álvareza, A. Bustinza Arriortúaa, I. Sancho Péreza, D. Vigil Escribanob
a Sección de Cuidados Intensivos Pediátricos. Servicio de Medicina Preventiva y Gestión de Calidad. Hospital General Universitario Gregorio Marañón. Madrid. España
b Unidad de Investigación. Servicio de Medicina Preventiva y Gestión de Calidad. Hospital General Universitario Gregorio Marañón. Madrid. España
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Objetivo

Estudiar la utilidad y eficacia de la nutrición enteral transpilórica (NET) en el niño críticamente enfermo, analizando los factores que influyen en la tolerancia digestiva

Pacientes y métodos

Estudio prospectivo observacional realizado entre 1994 y 2002, de los niños críticamente enfermos, ingresados que recibieron NET. En este estudio se analizan las indicaciones, el tipo de nutrición y su duración

Resultados

Se incluyen 286 pacientes (el 8,4 % de los pacientes ingresados en la unidad de cuidados intensivos pediátricos), de edades entre 3 días y 17 años de edad recibieron nutrición transpilórica: 55 niños (19,2 %) eran menores de un mes de vida, y 165 (57,7 %), menores de 6 meses. El 70% recibieron exclusivamente NET. La indicación más frecuente de NET fue la ventilación mecánica, en 255 niños (89,2 %). Recibieron NET en el postoperatorio de cirugía cardíaca 176 pacientes (61,5 %). La duración media de la NET fue 15,4 ± 25 días, el volumen máximo de 118,7 ± 41ml/kg/día y las calorías máximas de 88,6 ± 26,7kcal/kg/ día. Durante la NET, 227 pacientes recibieron sedantes y analgésicos (79,3 %), y 124 relajantes musculares (43,3 %), sin modificar la tolerancia

Conclusiones

La NET es una técnica de alimentación útil en el niño críticamente enfermo

Palabras clave:
Nutrición enteral transpilórica
Niño críticamente enfermo
Cuidados intensivos pediátricos
Nutrición enteral
Objective

To study the utility and efficacy of transpyloric enteral nutrition (TEN) in critically-ill children by analyzing the factors that determine enteral tolerance

Patients and methods

We performed a prospective, observational study between 1994 and 2002 of all critically-ill children admitted to our pediatric intensive care unit who received TEN. The indications for enteral nutrition, type of nutrition and its duration were studied

Results

A total of 286 patients (8.4 % of patients admitted to the PICU in the study period), aged between 3 days and 17 years received TEN. Fifty-five children (19.2 %) were aged less than 1 month and 165 (27.7 %) were aged less than 6 months. Seventy percent received TEN exclusively. The most frequent indication for TEN was mechanical ventilation in 255 children (89.2 %). One hundred seventy-six patients (61.5 %) received TEN in the postoperative period after cardiac surgery. The mean duration of TEN was 15.4 ± 25 days, the maximum volume of nutrition was 118.7 ± 41ml/kg/day, and the maximum caloric intake was 88.6 ± 26.7kcal/kg/day. During TEN, 227 patients received sedation (79.3 %), and 124 were administered muscle relaxants (43.3 %), with no increase in complications

Conclusions

TEN is a useful method of nutrition in critically-ill children

Key words:
Transpyloric enteral nutrition
Critically-ill children
Pediatric intensive care
Enteral nutrition
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Bibliografía
[1.]
J.M. Kinney.
Metabolic responses of the critically ill patient.
Crit Care Clin, 11 (1995), pp. 569-585
[2.]
R. Chang, S. Jacobs, B. Lee.
Gastrointestinal dysfunction among intensive care patients.
Crit Care Med, 10 (1987), pp. 909-914
[3.]
T.M. Lara, D.O. Jacobs.
Effect of critical illness and nutritional support on mucosal mass and function.
Clin Nutr, 17 (1998), pp. 99-105
[4.]
M.M. Pollack, U.E. Ruttimann, J.S. Wiley.
Nutritional depletion in critically ill children: Association with physiologic instability and increase quantity of care.
Jpen, 9 (1985), pp. 309-313
[5.]
J.F. Riera-Fanego, M. Wells, J. Lipman.
Nutritional inadequacy in paediatric ICU patients. An independent risk factor for mortality not assessed by PRISM.
Intensive Care Med, 21 (1995), pp. 32
[6.]
R.L. Koretz.
Nutritional supplementation in the ICU. How critical is nutrition for the critically ill?.
Am J Respir Infect Dis, 9 (1994), pp. 248-255
[7.]
C. Galbán, J.C. Montejo, A. Mesejo, P. Marco, S. Celaya, J.M. Sánchez- Segura, et al.
An inmune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients.
Crit Care Med, 28 (2000), pp. 643-648
[8.]
R.J. Hadfield, D.G. Sinclair, P.E. Houldsworth, T.W. Evans.
Effects of enteral and parenteral nutrition on gut mucosal permeability in the critically ill.
Am J Respir Crit Care Med, 152 (1995), pp. 1545-1548
[9.]
C.M. Dunham, D. Frankelfield, H. Belzberg, C. Wiles, B. Cushing, Z. Grantz.
Gut failure-predictor of or contributor to mortality in mechanically ventilated blunt trauma patients?.
J Trauma, 37 (1994), pp. 30-34
[10.]
M.J. Chellis, S.V. Sanders, H. Webster, J.M. Dean, D. Jackson.
Early enteral feeding in the pediatric intensive care unit.
Jpen, 20 (1996), pp. 71-73
[11.]
E. Panadero, J. López-Herce, L. Caro, A. Sánchez, E. Cueto, A. Bustinza, et al.
Transpyloric enteral feeding in critically ill children.
J Pediatr Gastroenterol Nutr, 26 (1998), pp. 43-48
[12.]
C. Sánchez, E. Panadero, M. Hortelano, E. García, A. Izquierdo, J. López-Herce.
Enterocolitis necrotizante en el postoperatorio de cirugía cardíaca en el período neonatal.
An Esp Pediatr, 49 (1998), pp. 185-187
[13.]
C. De Lucas, M. Moreno, J. López-Herce, F. Ruiz, M. Pérez-palencia, A. Carrillo.
Transpyloric enteral nutrition reduces the complication rate and cost in the critically ill child.
J Pediatr Gastroenterol Nutr, 30 (2000), pp. 175-180
[14.]
C. Sánchez, J. López-Herce, M. Moreno de Guerra, A. Carrillo, R. Moral, L. Sancho.
The use of transpyloric enteral nutrition in the critically ill child.
J Intensive Care Med, 15 (2000), pp. 247-254
[15.]
M.J. Chellis, S.V. Sanders, M. Dean, D. Jackson.
Bedside transpyloric tube placement in the pediatric intensive care unit.
Jpen, 20 (1996), pp. 88-90
[16.]
E.J. Glass, R. Hume, M.A. Lang, J.O. Folfar.
Parenteral nutrition compared with transpyloric feeding.
Arch Dis Child, 59 (1984), pp. 131-135
[17.]
R. Pettignano, M. Heard, R. Davis, M. Labuz, M. Hart.
Total enteral nutrition versus total parenteral nutrition during pediatric extracorporeal membrane oxygenation.
Crit Care Med, 26 (1998), pp. 358-366
[18.]
K.A. Kennedy, J.E. Tysson, S. Chamnanvanikij.
Early versus delayed initiation of progressive enteral feeding for parenteral fed low birth weight or preterm infants.
Cochrane Database Syst Rev, 2 (2000), pp. CD001970
[19.]
M. Planas.
y Grupo de Metabolismo y Nutrición de la SEMIUC. Nutrición enteral en Medicina Intensiva.
Med Intensiva, 18 (1994), pp. 381-385
[20.]
G.P. Zaloga.
Early enteral nutritional support improves outcome: Hypothesis or fact?.
Crit Care Med, 27 (1999), pp. 259-261
[21.]
R. Beier-Holgersen, S. Boesby.
Influence of postoperative enteral nutrition on postsurgical infections.
Gut, 39 (1996), pp. 833-835
[22.]
J.M. Watters, S.M. Kirkpatrick, S.B. Norris, F.M. Shamji, G.A. Wells.
Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased morbility.
Ann Surg, 226 (1997), pp. 369-380
[23.]
H.K. Spalding, K.J. Sullivan, O. Soremi, F. González, S.R. Goodwin.
Bedside placement of transpyloric feeding tubes in the pediatric intensive care unit using gastric insufflation.
Crit Care Med, 28 (2000), pp. 2041-2046
[24.]
J.J. Verhoeven, J.A. Hazelzet, E. Van der Voort, K.F. Joosten.
Comparison of measured and predicted energy expenditure in mechanically ventilated children.
Intensive Care Med, 24 (1998), pp. 464-468
[25.]
G. Briassoulis, S. Venkataraman, A.E. Thompson.
Energy Expenditure in critically ill children.
Crit Care Med, 28 (2000), pp. 1166-1172
[26.]
T.F. Müller, A. Müller, M.G. Bachem, H. Lange.
Immediate metabolic effects of different nutritional regimens in critically ill medical patients.
Intensive Care Med, 21 (1995), pp. 561-566
[27.]
D.C. Rankenfield, J.S. Smith, R.N. Cooney.
Accelerated nitrogen loss after traumatic injury is not attenuated by achievement of energy balance.
Jpen, 21 (1997), pp. 324-329
[28.]
D.K. Heyland, D.J. Cook, G.H. Guyatt.
Enteral nutrition in the critically ill patient: A critical review of the evidence.
Intensive Care Med, 19 (1993), pp. 435-442
[29.]
M.A. Montecalvo, K.A. Steger, H.W. Farber, B.F. Smith, R.C. Dennis, G.F. Fitzpatrick, et al.
Nutritional outcome and pneumonia in critical care patients randomized to gastric versus jejunal tube feedings.
Crit Care Med, 10 (1992), pp. 1377-1387
[30.]
J. Esparza, M.A. Boivin, M.F. Hartshorne, H. Levy.
Equal aspiration rates in gastrically and transpylorically fed critically ill patients.
Intensive Care Med, 27 (2001), pp. 660-664
[31.]
H. Mentec, H. Dupont, M. Bochetti, P. Cani, F. Ponche, G. Bleichner.
Upper digestive intoleance during enteral nutrition in critically ill patients: Frequency, risk factors and complications.
Crit Care Med, 29 (2001), pp. 1955-1961
[32.]
D.K. Heyland, D.J. Cook, B. Winder, L. Brylowsky, H. Van de Ark, H. Guya.
Enteral nutrition in the critically ill: A prospective survey.
Crit Care Med, 23 (1995), pp. 1055-1059
Copyright © 2003. Asociación Española de Pediatría
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