Estado nutricional de pacientes en una sala de rehabilitación posterapia intensiva por COVID-19

Julieta Adaglio; Luisina del Rio; Mirta Antonini; Romina Sayar

doi:10.35454/rncm.v7n2.576

Autores

Julieta Adaglio Hospital General de Agudos Juan A. Fernández. Cerviño 3356, CABA, Argentina.
Luisina del Rio Hospital General de Agudos Juan A. Fernández. Cerviño 3356, CABA, Argentina.
Mirta Antonini Hospital General de Agudos Juan A. Fernández. Cerviño 3356, CABA, Argentina.
Romina Sayar Hospital General de Agudos Juan A. Fernández. Cerviño 3356, CABA, Argentina.

DOI:

https://doi.org/10.35454/rncm.v7n2.576

Palavras-chave:

desnutrição, avaliação nutricional, dinamometria manual, reabilitação, COVID-19

Resumo

Introdução: a permanência prolongada na Unidade de Terapia Intensiva (UTI) é um fator de risco para a desnutrição. A intervenção nutricional precoce com reabilitação intensiva em regime de in- ternamento permite recuperação da força muscular e do estado nutricional.

Objetivo: determinar a evolução do es- tado nutricional dos doentes pós-UTI com COVID-19 em uma Sala de Reabilitação (SaRIP).

Métodos: estudo descritivo e prospetivo en doentes internados na SaRIP após per- manência prolongada na UTI por COVID-19. Foram avaliados o peso e o Índice de Massa Corporal (IMC) em três momentos, o esta- do nutricional de acordo com a Avaliação Global Subjetiva (ASG) e a força muscular com dinamometria manual em dois mo- mentos. Foi calculada a média e o desvio padrão e a associação entre as variáveis foi avaliada com o teste do qui-quadrado ou teste de Fisher e Wilcoxon, considerando um nível de significância de p<0,05.

Resultados: foram incluídos 42 doen- tes, 69,00 % do sexo masculino, com uma média de idades de 57,2±13 anos. O IMC médio de admissão na SaRIP foi de 26,82±5,32 kg/m2 e da alta 26,99±5,15 kg/m2 (p=0,736). De acordo com a ASG, 88,10 % apresentaram desnutrição na ad- missão e 42,86 % na alta (p=0,002). 50% apresentaram ganho de peso com uma

média de 2,73±2,07 kg e 100 % apresenta- ram aumento da força de preensão palmar com uma média de 3,97±3,64 kg.

Conclusões: a maioria dos doentes foi admitida no SaRIP com desnutrição e na data de alta verificou-se uma melhoria do estado nutricional, embora uma grande parte continuasse com alguma alteração e necessitasse de suplementação oral e acompanhamento nutricional.

Downloads

Não há dados estatísticos.

Referências

Singhal T. A Review of Coronavirus Disease-2019 (COVID-19). Indian J Pediatr. 2020; 87(4):281-286.doi: 10.1007/s12098-020-03263-6.

Argento FJ, Rodríguez Cairoli F, Perelli L, Augustovski F, Pichón-Riviére A, Bardach A. Parámetros esenciales para utilizar en modelos epidemiológicos de COVID-19 en Argentina: una revisión rápida. Rev Argent Salud Publica. 2021;13(Supl COVID-19):e24.

González-Castro A, Escudero-Acha P, Peñasco Y, Leizaola O, Martínez de Pinillos Sánchez V, García de Lorenzo A. Cuidados intensivos durante la epidemia de coronavirus 2019. Med Intensiva. 2020; 44(6); 351-362. doi: 10.1016/j.medin.2020.03.001.

Burgos PR, Desnutrición y enfermedad. Nutr Hosp. 2013; 6 (1):10-23. ISSN 1888-7961.

Crivelli A, Perman M, Wyszynski D, Alomar F, Bellone M, De Loredo L, et al. Estudio AANEP 99: Prevalencia de desnutrición en hospitales de la Argentina. [Internet]. 2001;10:121-34. [Citado 20 sep 2023]. Disponible en: https://www.researchgate.net/publication/261287437

Gómez-Santa MO, Velázquez-Alva M, Cabrera-Rosales M. Desnutrición en el paciente con COVID-19 y pérdida de masa muscular. Med Int Méx. 2020; 36(Supl 4):S14-S17. doi: 10.24245/mim. v36id.4966.

Li T, Zhang Y, Gong C, Wang J, Liu B, Shi L, et al. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr. 2020; 74(6): 871-875. doi: 10.1038/s41430-020-0642-3.

Bedock, D, Couffignal J, Bel Lassen P, Soares L, Mathian A, Fadlallah JP, et al. Evolution of Nutritional Status after Early Nutritional Management in COVID-19 Hospitalized Patients. Nutrients. 2021; 13(7): 2276. doi:10.3390/nu13072276.

Di Filippo L, De Lorenzo R, D'Amico M, Sofia V, Roveri L, Mele R, et al. COVID-19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation: A post-hoc analysis of a prospective cohort study. Clin Nutr. 2021; 40(4): 2420-2426. doi: 10.1016/j.clnu.2020.10.043.

Barazzoni R, Bischoff SC, Breda J, Wickramasinghe K, Krznaric Z, Nitzan D, et al. Espen expert statements and practical guidance for nutritional management of individuals SARS-CoV-2 infection. Clin Nutr. 2020; 39(6): 1631-1638. doi: 10.1016/j.clnu.2020.03.022.

Gemelli Against COVID-19 Post-Acute Care Study Group. Post-COVID-19 global health strategies: the need for an interdisciplinary approach. Aging Clin Exp Res. 2020; 32(8): 1613-1620. doi: 10.1007/s40520-020-01616-x.

Imamura M, Mirisola AR, Ribeiro FQ, De Pretto LR, Alfieri FM, Delgado VR, et al. Rehabilitation of patients after COVID-19 recovery: An experience at the Physical and Rehabilitation Medicine Institute and Lucy Montoro Rehabilitation Institute. Clinics (Sao Paulo). 2021; 76:e2804. doi: 10.6061/clinics/2021/e2804.

Gobbi M, Brunani A, Arreghini M, Baccalaro G, Dellepiane D, La Vela. V et al. Nutritional status in post SARS-Cov2 rehabilitation patients. Clin Nutr. 2022; 41(12): 3055-3060. doi: 10.1016/j.clnu.2021.04.013.

Fiorindi C, Campani F, Rasero L, Campani C, Livi L, Giovannoni L, et al. Prevalence of nutritional risk and malnutrition during and after hospitalization for COVID-19 infection: Preliminary results of a single-centre experience. Clin Nutr ESPEN. 2021; 45:351-355. doi: 10.1016/j.clnesp.2021.07.020.

Sousa-Catita D, Godinho C, Mascarenhas P, Quaresma F, Fonseca J. The Effects of an Intensive Rehabilitation Program on the Nutritional and Functional Status of Post-COVID-19 Pneumonia Patients. Nutrients. 2022; 14(12): 2501. doi: 10.3390/nu14122501.

Haraj NE, El Aziz S, Chadli A, Dafir A, Mjabber A, Aissaoui O, et al. Nutritional status assessment in patients with Covid-19 after discharge from the intensive care unit. Clin Nutr ESPEN. 2021; 41: 423-428. doi: 10.1016/j.clnesp.2020.09.214.

Hoyois A, Ballarin A, Thomas J, Lheureux O, Preiser JC, Coppens E, et al. Nutrition evaluation and management of critically ill patients with COVID-19 during post–intensive care rehabilitation. JPEN J Parenter Enteral Nutr. 2021; 45(6):1153-1163. doi: 10.1002/jpen.2101.

Martillo MA, Dangayach NS, Tabacof L, Spielman LA, Dams-O'Connor K, Chan CC,et al. Postintensive Care Syndrome in Survivors of Critical Illness Related to Coronavirus Disease 2019: Cohort Study From a New York City Critical Care Recovery Clinic. Crit Care Med. 2021; 49(9):1427-1438. doi: 10.1097/CCM.0000000000005014.

Haines KJ, Berney S, Warrillow S, Denehy L. Long-term recovery following critical illness in an Australian cohort. J Intensive Care. 2018;6:8. doi:10.1186/s40560-018-0276.

Vickory F, Ridgeway K, Falvey J, Houwer B, Gunlikson J, Payne K, et al. Safety, Feasibility, and Outcomes of Frequent, Long-Duration Rehabilitation in an Inpatient Rehabilitation Facility After Prolonged Hospitalization for Severe COVID-19: An Observational Study. Phys Ther. 2021;101(11):pzab208. doi:10.1093/ptj/pzab208.

Gobierno de la Ciudad de Buenos AIres, Ministerio de Salud. Cómo funcionan las salas de Rehabilitación Intensiva post COVID-19: el caso de Carlos, paciente recuperado. [Internet]. 31 jul 2020. [Citado 20 sep 2023]. Disponible en: ttps://buenosaires.gob.ar/jefedegobierno/noticias/

Canicoba M, de Baptista GA, Visconti G. Funciones y competencias del nutricionista clínico. Documento de consenso de la Federación Latinoamericana de Terapia Nutricional, Nutrición clínica y Metabolismo. RCAN. 2013;23(1):146-172.

Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T. et al. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clin Nutr. 2019;38(1):1-9. doi: 10.1016/j.clnu.2018.08.002.

Organización Mundial de la Salud (OMS). Obesity: preventing and managing the global epidemic: report of a WHO consultation on obesity, Geneva, 3-5 June 1997. [Internet]. [Citado 20 sep 2023]. Disponible en: https://iris.who.int/handle/10665/63854

Lipschitz DA. Screening for nutritional status in the elderly. Prim Care. 1994;21 (1):55-67. PMID: 8197257.

Dodds RM, Syddall HE, Cooper R, Benzeval M, Deary IJ, Dennison EM, et al. Grip Strength across the Life Course: Normative Data from Twelve British Studies. PLoS ONE. 2014;9(12): e113637. doi: 10.1371/journal.pone.0113637.

Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status?. JPEN J Parenter Enteral Nutr. 1987;11(1):8-13. doi: 10.1177/014860718701100108.

Nakanishi, N.; Liu, K.; Kawakami, D.; Kawai, Y.; Morisawa, T.; Nishida et al. Post-Intensive Care Syndrome and its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives. J Clin Med. 2021 10(17):3870. doi: 10.3390/ jcm10173870.

Spruit MA, Holland AE, Singh SJ, Tonia T., WIlson CK, Troosters T. COVID-19: interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society- and American Thoracic Society-coordinated international task force. Eur Respir J 2020;56(6):2002197. doi: 10.1183/13993003.02197-2020.

Novak P, Cunder K, Petrovič O, Oblak T, Dular K, Zupanc A, et al. Rehabilitation of COVID-19 patients with respiratory failure and critical illness disease in Slovenia: an observational study. Int J Rehabil Res. 2022;1;45(1):65-71. doi: 10.1097/MRR.0000000000000513.

Woo H, Lee S, Lee HS, Chae HJ, Jung J, Song MJ et al. Comprehensive Rehabilitation in Severely Ill Inpatients With COVID-19: A Cohort Study in a Tertiary Hospital. 2022; 37(34):e262. doi: 10.3346/jkms.2022.37.e262

Cereda E, Clavé P, Collins PF, Holdoway A, Wischmeyer PE. Recovery Focused Nutritional Therapy across the Continuum of Care: Learning from COVID-19. Nutrients. 2021;13(9):3293. doi: 10.3390/nu13093293.

Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601–615. doi:10.1038/s41591-021-01283-z.

Yang J, Hu J, Zhu C. Obesity aggravates COVID-19: A systematic review and meta-analysis. J Med Virol;93(1):257-261. doi: 10.1002/jmv.26237.

Bedock D, Bel Lassen P, Mathian A, Moreau P, Couffignal J, Ciangura C, et al. Prevalence and severity of malnutrition in hospitalized COVID-19 patients. Clin Nutr ESPEN. 2020;40:214-219. doi: 10.1016/j.clnesp.2020.09.018.

Li T, Zhang Y, Gong C, Wang J, Liu B, Shi L, et al. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr. 2020;74(6):871-875. doi: 10.1038/s41430-020-0642-3.

Rives-Lange C, Zimmer A, Merazka A, Carette C, Martins-Bexinga A, Hauw-Berlemont C, et al. Evolution of the nutritional status of COVID-19 critically-ill patients: A prospective observational study from ICU admission to three months after ICU discharge. Clin Nutr. 2022;41(12):3026-3031. doi: 10.1016/j.clnu.2021.05.007.

Brugliera L, Spina A, Castellazzi P, Cimino P, Arcuri P, Negro A, et al. Nutritional management of COVID-19 patients in a rehabilitation unit. Eur J Clin Nutr. 2020;74(6):860-863. doi: 10.1038/s41430-020-0664-x.

Cederholm T. 4 years of the GLIM criteria: Where are we? Results of the GLIM survey. [Internet]. 2023. [Citado 02 oct 2023]. Disponible en: https://www.espen.org/files/glim/GLIMNiceWM2023.pdf

Barazzoni R, Jensen GL, Correia MITD, Gonzalez MC, Higashiguchi T, Shi HP, et al. Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition (GLIM) diagnosis of malnutrition. Clin Nutr. 2022;41(6):1425-1433. doi: 10.1016/j.clnu.2022.02.001.

Correia MITD, Tappenden KA, Malone A, Prado CM, Evans DE, Sauer AC, et al. Utilization and validation of the Global Leadership Initiative on Malnutrition (GLIM): A scoping review. Clin Nutr. 2022;41(3):687-697. doi: 10.1016/j.clnu.2022.01.018.

Pourhassan M, Cederholm T, Trampisch U, Volkert D, Wirth R. Inflammation as a diagnostic criterion in the GLIM definition of malnutrition-what CRP-threshold relates to reduced food intake in older patients with acute disease? Eur J Clin Nutr. 2022;76(3):397-400. doi: 10.1038/s41430-021-00977-4.

Stanojcic M, Finnerty CC, Jeschke MG. Anabolic and anticatabolic agents in critical care. Curr Opin Crit Care. 2016;22(4):325-31. doi: 10.1097/MCC.0000000000000330.