Avaliação pré-operatória: desenvolvimento de protocolo de avaliação e terapia nutricional para o Hospital das Clínicas da Faculdade de Medicina de Botucatu
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Data
2018-07-30
Autores
Carvalho, Paula Bernardo de
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Sabemos que o paciente que será submetido a procedimento cirúrgico estará sujeito ao estresse metabólico inerente ao próprio procedimento e às alterações na homeostase causadas pela doença de base. Assim, a avaliação e a terapia nutricional implementadas durante o perioperatório são de fundamental importância para que os indivíduos apresentem a melhor resposta possível a injúria decorrente da cirurgia, associada ao menor período de recuperação, de preferência sem complicações. A avaliação nutricional se mostra complexa a medida que leva em consideração vários fatores já que modernamente o conceito de desnutrição é amplo e avalia também o estado de inflamação sistêmico e não apenas o IMC. Em tempos nos quais temos cada vez mais pacientes obesos, porém desnutridos, uma avaliação ampla e multifatorial é imprescindível. Hoje contamos com escalas que nos ajudam a avaliar esses pacientes, entre elas o Nutritional Risk Screening (NRS) 2002, com medidas antropométricas e de composição corporal e a avaliação laboratorial, como por exemplo a dosagem da albumina. Objetivo: Criar um Manual e Protocolo de Avaliação Pré-operatória e de terapia nutricional no paciente cirúrgico a ser implantado e seguido no Hospital das Clínicas da Faculdade de Medicina de Botucatu. Método: Foi realizada revisão da Literatura de artigos relevantes e Diretrizes Brasileiras e Internacionais, utilizando a base de dados Pubmed. As palavras e expressões chaves utilizadas foram: “ Preoperative risk screening” “Preoperative nutritional risk stratification”, “Preoperative nutritional risk stratification”, “elective surgery” e “nutritional assesment”. A seguir foi desenvolvido um protocolo de avaliação e terapia nutricional levando-se em consideração a opinião de outros profissionais como nutricionistas, cirurgiões, anestesiologistas. Resultados: O protocolo foi realizado na forma de fluxograma para que possa ser utilizado de forma prática e rápida durante a avaliação de risco cirúrgico global. Foi utilizada a escala NRS 2002 e a concentração sérica de albumina como métodos de triagem. Além disso, conceitos como o da imunonutrição foram associados ao protocolo de acordo com o ESPEN 2017. Conclusão: O estabelecimento de um protocolo de avaliação de risco e terapia nutricional para o paciente cirúrgico vem preencher uma lacuna há muito tempo presente em nosso serviço. A materialização deste conteúdo em forma de fluxograma levando em consideração as principais diretrizes mundiais em terapia nutricional facilita a aplicabilidade do método e faz com que cada vez mais pacientes se beneficiem dessa avaliação e terapia durante o perioperatório.
Introduction: It´s known that the patient who will undergo a surgical procedure will be subject to the metabolic stress inherent in the procedure itself and the changes in homeostasis caused by the underlying disease. Thus, the evaluation and nutritional therapy implemented during the perioperative period are of fundamental importance for individuals to present the best possible response to injury due to surgery and the shortest recovery period, preferably without complications. Nutritional assessment is complex as it takes into account several factors, since the concept of malnutrition is broad and it also evaluates the state of systemic inflammation and not only BMI. Today, as we have a growing number of obese but malnourished patients, a comprehensive and multifactorial evaluation is essential. To make this evaluation possible we have scales that help us to evaluate these patients, among them the Nutritional Risk Screening (NRS) 2002, and the analysis of serum markers such as albumin. Objective: To create a Protocol for Pre-operative Evaluation and Nutritional Therapy in the surgical patient to be implanted and followed in the “Hospital das Clínicas da Faculdade de Medicina de Botucatu”. Method: The literature of relevant articles in Brazilian and International Guidelines hás been reviewed using the Pubmed database. Key words and phrases used were: "Preoperative risk screening", "Preoperative nutritional risk stratification", "Preoperative nutritional risk stratification", "elective surgery" and "nutritional assesment". A protocol for nutritional assessment and therapy was then developed, taking into account the opinion of other professionals such as nutritionists, surgeons and anesthesiologists. Results: The protocol was performed in the form of a flow chart so that it can be used in a practical and fast way during the evaluation of global surgical risk. The NRS 2002 scale and the serum albumin concentration were used as screening methods. In addition, concepts such as immunonutrition were associated with the protocol according to ESPEN 2017. Conclusion: The establishment of a protocol of risk assessment and nutritional therapy for the surgical patient has filled a longstanding gap in our service. The materialization of this content in the form of a flowchart taking into account the main global guidelines in nutritional therapy facilitates the applicability of the method and makes a growing number of patients benefit from this evaluation and therapy during the perioperative period.
Introduction: It´s known that the patient who will undergo a surgical procedure will be subject to the metabolic stress inherent in the procedure itself and the changes in homeostasis caused by the underlying disease. Thus, the evaluation and nutritional therapy implemented during the perioperative period are of fundamental importance for individuals to present the best possible response to injury due to surgery and the shortest recovery period, preferably without complications. Nutritional assessment is complex as it takes into account several factors, since the concept of malnutrition is broad and it also evaluates the state of systemic inflammation and not only BMI. Today, as we have a growing number of obese but malnourished patients, a comprehensive and multifactorial evaluation is essential. To make this evaluation possible we have scales that help us to evaluate these patients, among them the Nutritional Risk Screening (NRS) 2002, and the analysis of serum markers such as albumin. Objective: To create a Protocol for Pre-operative Evaluation and Nutritional Therapy in the surgical patient to be implanted and followed in the “Hospital das Clínicas da Faculdade de Medicina de Botucatu”. Method: The literature of relevant articles in Brazilian and International Guidelines hás been reviewed using the Pubmed database. Key words and phrases used were: "Preoperative risk screening", "Preoperative nutritional risk stratification", "Preoperative nutritional risk stratification", "elective surgery" and "nutritional assesment". A protocol for nutritional assessment and therapy was then developed, taking into account the opinion of other professionals such as nutritionists, surgeons and anesthesiologists. Results: The protocol was performed in the form of a flow chart so that it can be used in a practical and fast way during the evaluation of global surgical risk. The NRS 2002 scale and the serum albumin concentration were used as screening methods. In addition, concepts such as immunonutrition were associated with the protocol according to ESPEN 2017. Conclusion: The establishment of a protocol of risk assessment and nutritional therapy for the surgical patient has filled a longstanding gap in our service. The materialization of this content in the form of a flowchart taking into account the main global guidelines in nutritional therapy facilitates the applicability of the method and makes a growing number of patients benefit from this evaluation and therapy during the perioperative period.
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Palavras-chave
Avaliação de risco pré-operatório, Estratificação de risco nutricional pré-operatório, Cirurgia eletiva, Avaliação Nutricional, Preoperative risk assessment, Pre-operative nutritional risk stratification, Elective surgery, Nutrition assessment