Micronutrientes em doentes adultos em estado crítico: uma análise de escopo da suplementação parentérica
DOI:
https://doi.org/10.35454/rncm.v7n3.637Palavras-chave:
cuidados críticos, micronutrientes, oligoelementos, vitaminas, eletrolitos, revisãoResumo
Introdução: estima-se que a prevalência de desnutrição entre os pacientes hos- pitalizados seja de 30,00-50,00%. Objetivo: examinar a evidência publi- cada sobre a ingestão necessária de mi- cronutrientes e cálcio em doentes adultos em estado crítico.Métodos: entre janeiro e novembro de 2023, uma busca foi realizada em várias bases de dados da literatura científica sem impor limitações estritas. A maioria dos estudos revisados foram meta-análises, ensaios clínicos randomizados e revisões sistemáticas. Resultados: a administração de selênio correlaciona-se com a gravidade da sepse, porém, não é possível estabelecer uma recomendação. Sugere-se que as doses de zinco nas soluções de oligoelementos se- jam deficientes, sendo sua administração associada a uma menor mortalidade hos- pitalar. O aporte de cálcio pode melhorar a sobrevivência em 28 dias, com seu dé- ficit associado a uma maior mortalidade; no entanto, se a hipocalcemia for leve ou assintomática, não se recomenda suple- mentação. Da mesma forma, os resultados obtidos em relação às diferentes vitami- nas analisadas (C, D, E) indicam que a su- plementação não pode ser recomendada. Conclusões: o fornecimento de baixas doses de oligoelementos e vitaminas é seguro e justificado. Em relação às vitami- nas E, D, selênio e zinco, existem estudos contraditórios, não sendo estabelecida uma recomendação precisa para pacien- tes com necessidades aumentadas. A ad- ministração de vitamina C em altas doses não parece apresentar nenhum efeito clínico significativo em pacientes sépticos. Nenhuma orientação recomenda a suple- mentação de hipocalcemia leve.
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