El Proyecto ACERTO: un protocolo multimodal barato y eficaz para América Latina

José de Aguilar Nascimento

doi:10.35454/rncm.v3n1.018

Authors

José de Aguilar Nascimento

DOI:

https://doi.org/10.35454/rncm.v3n1.018

Keywords:

Peri-operative care, Preoperative fasting, Nutritional therapy, Postoperative complications, Intravenous fluids, Preoperative colonic preparation

Abstract

The ACERTO project is a multimodal peri-operative care program. The set of routines and prescriptions of the ACERTO project is based on evidence-based medicine as opposed to traditional care, often empirical and taught in the same routine by successive generations of surgeons. Traditional care such as the use of nasogastric tube, abdominal drainage, preoperative colonic preparation, preoperative fasting of 6-8 hours are modified in the project based on evidence from randomized studies and meta-analysis. In addition, the project reinforces the restriction of intravenous fluids and the use of nutritional therapy in the peri-operative. The application of the ACERTO project since 2005 has been modifying results, showing significant reduction of hospitalization days and postoperative morbidity in successive clinical studies. The ACERTO project is free to use.

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References

Polk HC Jr, Birkmeyer J, Hunt DR, Jones RS, Whittermore AD, Barraclough B. Quality and Safety in Surgical Care. Ann Surg. 2006; 243(4):439–48.

Schifftner TL, Grunwald GK, Henderson WG, Main D, Khuri SF. Relationship of processes and structures of care in general surgery to postoperative outcomes: a hierarchical analysis. J Am Coll Surg. 2007; 204(6):1166–77.

Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002; 183(6):630–41.

Fearon KC, Ljungqvist O, von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery. a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005; 24(3):466-77.

Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT, et al. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg. 2006; 93(7):800–9.

Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg. 2007; 245(6):867-72.

Rede Interagencial de Informações para a Saúde (RIPSA). Indicadores de recursos [Internet]: IDB, Brasil; 2007 Fecha de consulta: 15 de outubro de 2018]. Disponible en: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?idb2007/e11.def.

de-Aguilar-Nascimento JE, Bicudo-Salomão A, Caporossi C, Silva RM, Cardoso EA, Pádua Santos T. Volume de fluído intravenoso e alta hospitalar precoce em colecistectomia aberta. Rev Col Bras Cir. 2007; 34(6):381-4.

de-Aguilar-Nascimento JE, Bicudo Salomão A, Waitzberg DL, Dock-Nascimento DB, Correa MITD, Campos ACL, et al. Diretriz ACERTO de intervenções nutricionais no perioperatório em cirurgia geral eletiva. Rev Col Bras Cir. ٢٠١٧; ٤٤(٦):633-48.

Warner MA. Is pulmonary aspiration still an import problem in anesthesia? Current Opin Anaesthesiol. 2000;13(2):215-8.

Aguilar-Nascimento JE, de Almeida Dias AL, Dock-Nascimento DB, Correia TDMI, Campos ACL, Portari-Filho PE, et al. Actual preoperative fasting time in Brazilian hospitals: the BIGFAST multicenter study. Ther Clin Risk Manag. 2014;10:107-12.

de-Aguilar-Nascimento JE, Bicudo-Salomão A, Caporossi C, de-Melo Silva R, Cardoso EA, Pádua Santos T. Acerto pós-operatório: avaliação dos resultados da implantação de um protocolo multidisciplinar de cuidados peri-operatórios em cirurgia geral. Rev Col Bras Cir. 2006; 33(3):181-8.

Cahill GF Jr. Starvation in man. N Engl J Med. 1970; 282(12):668-75.

Faria MS, de Aguilar-Nascimento JE, Pimenta OS, Alvarenga LC Jr, Dock-Nascimento DB, Slhessarenko N. Preoperative fasting of 2 hours minimizes insulin resistance and organic response to trauma after video-cholecystectomy: a randomized, controlled, clinical trial. World J Surg. 2009; 33(6):1158-64.

Davisson Correia MIT, Gomes da Silva R. Paradigmas e evidências da nutrição peri-operatória. Rev Col Bras Cir. 2005;32(6):342-7.

Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003;(4):CD004423.

Lobo DN, Hendry PO, Rodrigues G, Marciani L, Totman JJ, Wright JW, et al. Gastric emptying of three liquid oral preoperative metabolic preconditioning regimens measured by magnetic resonance imaging in healthy adult volunteers: a randomised double-blind, crossover study. Clin Nutr. 2009; 28(6):636-41.

Perrone F, Aguilar-Nascimento JE, Prado LI, Rabello S, Dock-Nascimento DB. Reducing preoperative fasting with carbohydrates and whey protein reduces the inflammatory response after elective operations. A randomized trial. Clin Nutr Supplements. 2010; 5(2):196-7.

Awad S, Blackshaw Pe, Wright JW, Macdonald IA, Perkins AC, Lobo DN. A randomized crossover study of the effects of glutamine and lipid on the gastric emptying time of a preoperative carbohydrate drink. Clin Nutr. 2010; 30(2):165-71.

Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003;238(5):641-8.

Powell-Tuck J, Gosling P, Lobo DN, Allison SP, Carlson GL, Gore M, et al GIFTASUP (British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients) [Internet]. Londres: NHS National Library of Health [Fecha de consulta: 8 de abril de 2019]. Disponible en: https://www.bapen.org.uk/pdfs/bapen_pubs/giftasup.pdf

Stewart BT, Woods RJ, Collopy BT, Fink RJ, Mackay JR, Keck JO. Early feeding after elective open colorectal resections: a prospective randomized trial. Aust N Z J Surg. 1998; 68(2):125-8.

de-Aguilar-Nascimento JE, Göelzer J. [Early feeding after intestinal anastomoses: risks or benefits?] Rev Assoc Med Bras. 2002; 48(4):348-52.

Lassen K, Dejong CH, Ljunggvist O, Fearon K, Andersen J, Hannemann P, et al. Nutrional support and oral intake after gastric resection in five northern European countries. Dig Surg. 2005; 22(5):346-52.

Lewis SJ, Egger M, Sylvester PA, Thomas S. Early enteral feeding versus ‘‘nil by mouth’’ after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ. 2001; 323(7316):773–6.

Senkal M, Mumme A, Eickhoff U, Geier B, Wulfert D, Joosten D, et al. Early postoperative enteral immunonutrition: clinical outcome and cost-comparison analysis in surgical patients. Crit Care Med. 1997; 25(9):1489–96.

Behm B, Stollman N. Postoperative ileus: etiologies and interventions. Clin Gastroenterol Hepatol. 2003;1(2):71-80.

Nichols RL, Smith JW, Garcia RY, Waterman RS, Holmes JW. Current practices of preoperative bowel preparation among North American colorectal surgeons. Clin Infect Dis. 1997;24(4):609-19.

Peppas G, Alexiou VG, Falagas ME. Bowel cleansing before bowel surgery: major discordance between evidence and practice. J Gastrointest Surg. 2008; 12(5):919-20.

Drummond RJ, McKenna RM, Wright DM. Current practice in bowel preparation for colorectal surgery: a survey of the members of the Association of Coloproctology of GB & Ireland. Colorectal Dis. 2011;13(6):708-10.

Wille-Jørgensen P, Guenaga KF, Castro AA, Matos D. Clinical value of preoperative mechanical bowel cleansing in elective colorectal surgery: a systematic review. Dis Colon Rectum. 2003; 46(8):1013-20.

Slim K, Vicaut E, Panis Y, Chipponi J. Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel. Br J Surg. 2004; 91(9):1125-30.

Bucher P, Mermillod B, Gervaz P, Morel P. Mechanical bowel preparation for elective colorectal surgery: a meta-analysis. Arch Surg. 2004;139(12):1359-64.

Guenaga KF, Matos D, Castro AA, Atallah AN, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2003;(2):CD001544.