Quality indicators for enteral and parenteral nutrition therapy: application in critically ill patients «at nutritional risk»

espanolIntroduccion: los indicadores de calidad en terapia nutricional (ICTN) permiten evaluar la calidad de la terapia nutricional (TN) de forma practica. Objetivo: implementar y monitorizar los ICTN en pacientes criticos con riesgo nutricional. Metodos: estudio transversal con pacientes criticos > 18 anos en riesgo nutricional, en terapia nutricional enteral (TNE) o parenteral (TNP) exclusiva a > 72 horas. Despues de 3 anos consecutivos, 9 ICTN fueron implementados y monitorizados. El analisis estadistico fue realizado con el software SPSS, version 17.0. Resultados: fueron incluidos 145 pacientes, siendo 93 en TNE, 65% eran de sexo masculino, con edad promedio de 55,7 anos (± 17,4); 52 pacientes que estaban en TNP, 67% eran de sexo masculino, con edad promedio de 58,1 anos (± 17,4). Todos los pacientes (TNE y TNP) fueron cribados en la admision, los calculos de las necesidades caloricas y proteinicas fueron individualizados. Apenas la TNE fue precoz, > 70% del volumen prescrito fue administrado y fue visto una reducida perdida de la sonda nasoenteral. Las frecuencias de diarrea y ayuno digestivo no fueron adecuadas en TNE. La administracion adecuada de energia fue contemplada apenas en TNP y hubo una signifi cativa tendencia de recuperacion en la via oral en TNE. Conclusion: despues de 3 anos de estudio, el porcentaje de adecuacion de los ICTN vario entre 55%-77% para TNE y 60%-80% para TNP. Los resultados reflejan los esfuerzos del equipo multiprofesional de TN en mantener la calidad de la asistencia nutricional en los pacientes criticos con riesgo nutricional. EnglishIntroduction: Quality Indicators for Nutritional Therapy (QINT) allow a practical assessment of nutritional therapy (NT) quality. Objective: To apply and monitor QINT for critically ill patients at nutritional risk. Methods: Cross sectional study including critically ill patients > 18 years old, at nutritional risk, on exclusive enteral (ENT) or parenteral nutritional therapy (PNT) for > 72 hours. After three consecutive years, 9 QINT were applied and monitored. Statistical analysis was performed with SPSS version 17.0. Results: A total of 145 patients were included, 93 patients were receiving ENT, among then 65% were male and the mean age was 55.7 years (± 17.4); 52 patients were receiving PNT, 67% were male and the mean age was 58.1 years (± 17.4). All patients (ENT and PNT) were nutritionally screened at admission and their energy and protein needs were individually estimated. Only ENT was early initiated, more than 70% of the prescribed ENT volume was infused and there was a reduced withdrawal of enteral feeding tube. The frequency of diarrhea episodes and digestive fasting were not adequate in ENT patients. The proper supply of energy was contemplated only for PNT patients and there was an expressive rate of oral intake recovery in ENT patients. Conclusion: After three years of research, the percentage of QINT adequacy varied between 55%-77% for ENT and 60%-80% for PNT. The results were only made possible by the efforts of a multidisciplinary team and the continuous re-evaluation of the procedures in order to maintain the nutritional assistance for patients at nutritional risk.