Gastrointestinal changes in critical patients with covid-19 receiving enteral nutritional, neuromuscular blockers and/or vasoactive drugs
DOI:
https://doi.org/10.21527/2176-7114.2024.48.13615Keywords:
Enteral Nutrition, Neuromuscular Blocking Agents, Vasoconstrictor Agents, COVID-19, Critical CareAbstract
Objective: The aim of this study was to evaluate the frequency of gastrointestinal alterations (GIA) and possible associated risk factors in critically ill patients with COVID-19 receiving enteral nutrition (EN) concomitantly with vasoactive drug (VAD) and/or neuromuscular blockers (NMB). Methods: Retrospective cohort study, performed in intensive care units (ICU), with individuals over 18 years of age with COVID-19 who received concomitant exclusive EN with at least one VAD and/or one NMB in ≥ 1 day. GIA were: presence of ≥ 1 of the following changes: diarrhea (≥ 3 liquid stools/day), gastric residual volume (GRV), paralysis of the lower gastrointestinal tract (GIT) (absent evacuation for ≥ 3 consecutive days), emesis and gastrointestinal bleeding. A mixed logistic regression was used to assess the association of drugs with GIA and a multivariate logistic regression to assess potential confounders. Results: We evaluated 78 individuals and 774 days of hospitalization. All of them received EN within 48h and 70.5% died. The most frequent GIA were: lower GIT paralysis, 75 patients in 362 days; GRV, 18 patients at 34 days and diarrhea, 13 patients at 22 days. Norepinephrine was associated with GRV (p=0.003) and fentanyl (mcg/min) with the presence of GIA (p=0.029). Conclusions: The NMB showed no relationship with the assessed GIA, as for the VAD we suggest the assessment of norepinephrine as a possible risk factor for GRV.
References
Li L, Li R, Wu Z, Yang Y, Zhao M, Liu J, et al. Therapeutic strategies for critically ill patients with COVID-19. Ann Intensive Care. 2020;10(1):1-9.
World Health Organization (WHO). Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance, 13 March 2020;2020;1-19.
Castro MG, Ribeiro PC, Souza IAO, Cunha HFR, Silva MHN, Rocha EEM, et al. Diretriz Brasileira de Terapia Nutricional no Paciente Grave. BRASPEN Journal. 2018;33(1):1-108.
McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enter Nutr. 2016;40(2):159-211.
Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79.
Merchan C, Altshuler D, Aberle C, Papadopoulos J, Schwartz D. Tolerability of Enteral Nutrition in Mechanically Ventilated Patients With Septic Shock Who Require Vasopressors. J Intensive Care Med. 2017;32(9):540-546.
Simoes Covello LH, Gava-Brandolis MG, Castro MG, Dos Santos Netos MF, Manzanares W, Toledo DO. Vasopressors and Nutrition Therapy: Safe Dose for the Outset of Enteral Nutrition? Crit Care Res Pr. 2020;2020:1-7
Tezcan B, Turan S, Özgök A. Current Use of Neuromuscular Blocking Agents in Intensive Care Units. Turk J Anaesthesiol Reanim. 2019;47(4):273-281.
Tamion F, Hamelin K, Duflo A, Girault C, Richard JC, Bonmarchand G. Gastric emptying in mechanically ventilated critically ill patients: Effect of neuromuscular blocking agent. Intensive Care Med. 2003;29(10):1.717-1.722.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40(5):373-383.
Detsky AS, Mclaughlin J, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? J Parenter Enter Nutr. 1987;11(1):8-13.
World Health Organization (WHO). Obesity:preventing and managing the global epidemic. 2000;1-268.
Lipschitz DA., Lipschitz DA. Screening for nutritional status in the elderly. Prim Care. 1994;21(1):55-67.
Chumlea WC, Roche AF, Steinbaugh ML. Estimating Stature from Knee Height for Persons 60 to 90 Years of Age. J Am Geriatr Soc. 1985;33(2):116-120.
Chumlea WMC, Guo SS, Steinbaugh ML. Prediction of stature from knee height for black and white adults and children with application to mobility-impaired or handicapped persons. J Am Diet Assoc. 1994;94(12):1.385-1.391.
Mussoi TD. Avaliação nutricional na prática clínica: da gestação ao envelhecimento. 1. ed. Rio de Janeiro: Guanabara Koogan; 2014. Vol. 148.
Zanten ARH Van, Waele E De, Wischmeyer PE. Nutrition therapy and critical illness: practical guidance for the ICU, post-ICU, and long-term convalescence phases. Crit Care. 2019;23(368):1-10.
Costa Junior VA da, Branco ALGC, Cavalcanti ALM, et al. Use of vasoactive drugs in the management of shock: a literature review. Res Soc Dev. 2022;11(10):e149111032453.
Adeyinka A, Layer DA. Neuromuscular Blocking Agents. Treasure Island (FL): StatPearls Publishing; 2023.
Renew JR, Ratzlaff R, Hernandez-Torres V, Brull SJ, Prielipp RC. Neuromuscular blockade management in the critically Ill patient. J intensive care. 2020;8(37)1-15.
Mancl EE, Muzevich KM. Tolerability and safety of enteral nutrition in critically ill patients receiving intravenous vasopressor therapy. JPEN J Parenter Enteral Nutr. 2013;37(5):641-651.
Blaser AR, Malbrain MLNG, Starkopf J, Fruhwal S, Jakob SM, Waele JD, et al. Gastrointestinal function in intensive care patients: Terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med. 2012;38(3):384-394.
Bates D, Mächler M, Bolker BM, Walker SC. Fitting Linear Mixed-Effects Models Using lme4. J Stat Softw. 2015;67(1):1-48.
Skrondal A, Rabe-Hesketh S. Generalized Latent Variable Modeling : Multilevel, Longitudinal, and Structural Equation Models. 1rd ed. Chapman & Hall/CRC; 2004. Vol. 1.
Agresti A. Categorical Data Analysis. 3rd ed. John Wiley & Sons; 2012.
Prat D, Messika J, Avenel A, Jacobs F, Fichet J, Lemeur M, et al. Constipation incidence and impact in medical critical care patients: importance of the definition criterion. Eur J Gastroenterol Hepatol. 2016;28(3):290-296.
Nassar AP, da Silva FMQ, de Cleva R. Constipation in intensive care unit: Incidence and risk factors. J Crit Care. 2009;24(4):630.e9-630.e12.
Barletta JF, Asgeirsson T, Senagore AJ. Influence of Intravenous Opioid Dose on Postoperative Ileus. Ann ofPharmacotherapy. 2011;45:916-923.
Osuna-Padilla I, Rodríguez-Moguel NC, Aguilar-Vargas A, Rodríguez-Llamazares S. Safety and tolerance of enteral nutrition in COVID-19 critically ill patients, a retrospective study. Clin Nutr ESPEN. 2021;43:495-500.
Limketkai BN, LeBrett W, Lin L, Shah ND. Nutritional approaches for gastroparesis. Lancet Gastroenterol Hepatol. 2020;5(11):1.017-1.026.
Associação de Medicina Intensiva Brasileira (AMIB). UTIs Brasileiras Registro Nacional de Terapia Intensiva. 2022. Available from: http://www.utisbrasileiras.com.br/sari-covid-19/benchmarking-covid-19/
Vavruk AM, Martins C, Mazza do Nascimento M. Validation of Malnutrition Clinical Characteristics in Critically Ill Patients. Nutr Clin Pract. 2021;36(5):993-1.002.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Revista Contexto & Saúde
This work is licensed under a Creative Commons Attribution 4.0 International License.
Autores que publicam na Revista Contexto & Saúde concordam com os seguintes termos:
a) A submissão de trabalho(s) científico(s) original(is) pelos autores, na qualidade de titulares do direito de autor do(s) texto(s) enviado(s) ao periódico, nos termos da Lei 9.610/98, implica na cessão de direitos autorais de publicação na Revista Contexto e Saúde do(s) artigo(s) aceitos para publicação à Universidade Regional do Noroeste do Estado do Rio Grande do Sul, autorizando-se, ainda, que o(s) trabalho(s) científico(s) aprovado(s) seja(m) divulgado(s) gratuitamente, sem qualquer tipo de ressarcimento a título de direitos autorais, por meio do site da revista e suas bases de dados de indexação e repositórios, para fins de leitura, impressão e/ou download do arquivo do texto, a partir da data de aceitação para fins de publicação. Isto significa que, ao procederem a submissão do(s) artigo(s) à Revista Contexto e Saúde e, por conseguinte, a cessão gratuita dos direitos autorais relacionados ao trabalho científico enviado, os autores têm plena ciência de que não serão remunerados pela publicação do(s) artigo(s) no periódico.
b). Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob a Licença Creative Commons Attribution que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista.
c). Autores têm autorização para assumir contratos adicionais separadamente, para distribuição não-exclusiva da versão do trabalho publicada nesta revista (ex.: publicar em repositório institucional ou como capítulo de livro), com reconhecimento de autoria e publicação inicial nesta revista.
d). Autores têm permissão e são estimulados a publicar e distribuir seu trabalho online (ex.: em repositórios institucionais ou na sua página pessoal) a qualquer ponto antes ou durante o processo editorial, já que isso pode gerar alterações produtivas, bem como aumentar o impacto e a citação do trabalho publicado (Veja O Efeito do Acesso Livre).
