RESUMO Objetivo: Avaliar os efeitos da administração intravenosa de fluidos e sódio no primeiro dia de internação com a infusão de nutrição enteral em pacientes de terapia intensiva. Métodos: Estudo de coorte prospectivo realizado com pacientes críticos, não cirúrgicos, em ventilação mecânica internados pelo menos há 5 dias com nutrição enteral. Investigaram-se a quantidade de fluidos e sódio administrados por via venosa no primeiro dia e o volume de nutrição enteral infundido nos primeiros 5 dias. Comparou-se o volume de fluidos intravenosos do primeiro dia > 35mL/kg ou ≤ 35mL/kg de peso corporal e de sódio (acima ou abaixo do percentil 25), com o total de nutrição enteral infundida. Resultados: Estudaram-se 86 pacientes com média (± desvio padrão) de 65 ± 17 anos, sendo 54,7% do sexo feminino. Foram administrados, no primeiro dia, 3.393,7 ± 1.417,0mL de fluidos (48,2 ± 23,0mL/kg) e 12,2 ± 5,1g de sódio. Cinquenta e oito (67,4%) pacientes receberam mais de 35mL/kg de fluidos. Em 5 dias, foram ofertados 67 ± 19,8% (2.993,8 ± 1.324,4mL) da nutrição enteral. Os pacientes que receberam > 35mL/kg de fluidos intravenosos também receberam menos nutrição enteral em 5 dias (2.781,4 ± 1.337,9 versus 3.433,6 ± 1.202,2mL; p = 0,03) versus quem recebeu ≤ 35mL/kg. Pacientes com infusão de sódio intravenoso acima do percentil 25 (≥ 8,73g) no primeiro dia receberam menos volume de nutrição enteral em 5 dias (2.827,2 ± 1.398,0 versus 3.509,3 ± 911,9mL; p = 0,02). Conclusão: Os resultados deste estudo apoiam o pressuposto de que a administração de fluidos intravenosos no primeiro dia de internação > 35mL/kg e de sódio ≥ 8,73g pode contribuir para a menor infusão de nutrição enteral em pacientes críticos.

ABSTRACT Objective: To evaluate the effects of intravenous infusion of fluids and sodium on the first day of admission on infusion of enteral nutrition in the first 5 days in intensive care patients. Methods: A prospective cohort study was conducted with critical nonsurgical patients admitted for at least 5 days who were on mechanical ventilation and receiving enteral nutrition. The amount of intravenous fluids and sodium infused on the first day and the volume of enteral nutrition infused in the first 5 days were investigated. The volume of intravenous fluids > 35mL/kg or ≤ 35mL/kg of body weight and sodium (above or below the 25th percentile) infused on the first day was compared with infused enteral nutrition. Results: A total of 86 patients were studied, with a mean (± standard deviation) of 65 ± 17 years, of which 54.7% were female. On the first day, 3,393.7 ± 1,417.0mL of fluid (48.2 ± 23.0mL/kg) and 12.2 ± 5.1g of sodium were administered. Fifty-eight (67.4%) patients received more than 35mL/kg of fluids. In 5 days, 67 ± 19.8% (2,993.8 ± 1,324.4mL) of the prescribed enteral nutrition was received. Patients who received > 35mL/kg of intravenous fluids also received less enteral nutrition in 5 days (2,781.4 ± 1,337.9 versus 3,433.6 ± 1,202.2mL; p = 0.03) versus those who received ≤ 35mL/kg. Patients with intravenous sodium infusion above the 25th percentile (≥ 8.73g) on the first day received less enteral nutrition volume in 5 days (2,827.2 ± 1,398.0 versus 3,509.3 ± 911.9mL; p = 0.02). Conclusion: The results of this study support the assumption that the administration of intravenous fluids > 35mL/kg and sodium ≥ 8.73g on the first day of hospitalization may contribute to the lower infusion of enteral nutrition in critically ill patients.

Abstract Introduction: intravenous fluid overload may lead to dysmotility that may impair early enteral nutrition delivery in critically ill patients. Objectives: this study aimed to compare the volume of intravenous fluids (IF) with the occurrence of caloric and protein deficits in Intensive Care Unit (ICU) patients. Methods: this cohort study included critically ill patients with mechanical ventilation and receiving early enteral nutrition (target: 25-30 kcal/kg/day and 1.25-2.0 g of protein/kg/day). Over the first five days the volume of IF infused and caloric/protein deficits were calculated. Results: eighty-six critically ill patients (SAPS III score: 62 ± 10) with a mean age of 68 (18-91) years were enrolled. Patients received a median of 2,969 (920-5,960) ml/day of IF, which corresponded to a median of 41.6 (17.0-88.2) ml/kg/day and 10.7 (3.31-21.45) g of sodium/day. All patients had a caloric deficit (mean: 1,812 ± 850 kcal over five days) and in 23 (27%) this deficit exceeded 480 kcal/day. The mean protein deficit was 94.6 ± 5.9 g over five days, and 34 patients (40%) had more than 20 g of deficit/day. Patients with caloric deficit greater than 480 kcal/day received approximately 1.5 l of IF and 10 g of NaCl more than the other patients. Similarly, patients with protein deficit greater than 20 g/day received approximately 3 l of IF and 25 g of NaCl more than the other patients. Mortality was greater in patients with critical protein deficit (69% vs 41.1%; p = 0.01). Conclusion: in critically ill patients receiving enteral nutrition, the volume of intravenous fluids infused affected nutrition delivery and increased caloric and protein deficits.

Resumen Introducción: la sobrecarga de líquidos por vía intravenosa puede provocar dismotilidad que puede afectar el suministro de nutrición enteral temprana en pacientes críticos. Objetivos: este estudio tuvo como objetivo comparar el volumen de líquidos por vía intravenosa (IF) con la aparición de déficit calórico y proteico en pacientes de la Unidad de Cuidados Intensivos (UCI). Métodos: este estudio de cohorte incluyó a pacientes críticamente enfermos con ventilación mecánica que recibían nutrición enteral temprana (target: 25-30 kcal/kg/día y 1,25-2,0 g de proteína/kg/día. Durante los primeros cinco días calculamos el volumen de IF y el déficit calórico/proteico. Resultados: ochenta y seis pacientes críticamente enfermos (SAPS III: 62 ± 10) con una edad media de 68 (18-91) años fueron estudiados. Los pacientes recibieron una mediana de 2.969 (920-5.960) ml/día de IF, que correspondió a una mediana de 41,6 (17,0-88,2) ml/kg/día y a 10,7 (3,31-21,45) g de sodio/día. Todos los pacientes tenían déficit calórico (media: 1.812 ± 850 kcal en cinco días) y en 23 (27%) este déficit excedía las 480 kcal/día. El déficit medio de proteínas fue de 94,6 ± 5,9 g en cinco días y 34 pacientes (40%) tuvieron más de 20 g de déficit/día. Los pacientes con un déficit calórico superior a 480 kcal/día recibieron aproximadamente 1,5 l de IF y 10 g de NaCl más que los otros pacientes. De forma similar, los pacientes con un déficit de proteínas mayor de 20 g/día recibieron aproximadamente 3 l de IF y 25 g de NaCl más que los otros pacientes. La mortalidad fue mayor en pacientes con déficit proteico crítico (69% vs. 41,1%; p = 0,01). Conclusión: en pacientes críticamente enfermos que reciben nutrición enteral, el volumen de líquidos intravenosos infundidos afecta el suministro de nutrición y aumenta el déficit de calorías y proteínas.