Avaliação de fatores de risco que levam o paciente crítico adulto à intolerância à terapia nutricional enteral: uma revisão da literatura
DOI:
https://doi.org/10.55892/jrg.v9i20.2864Palavras-chave:
lesão gastrointestinal aguda, fatores de risco, disfunção gastrointestinal, unidade terapia intensiva, nutrição enteralResumo
Na instabilidade hemodinâmica, o trato gastrointestinal é um dos primeiros órgãos afetados, comprometendo sua integridade, levando ao aumento da permeabilidade intestinal, apoptose celular, translocação bacteriana, e consequentemente à inflamação e disfunção. A disfunção gastrointestinal (DFGI), definida pela lesão gastrointestinal aguda (AGI), manifesta-se por distúrbios de motilidade e de absorção estando diretamente associada à intolerância à nutricional enteral (INE), maior tempo de internação, maior risco de infecção e aumento da mortalidade. Esta revisão integrativa da literatura, teve por objetivo analisar os fatores de risco associados à INE e sua aplicabilidade clínica. Foram incluídos 18 estudos publicados entre 2015 e 2025, envolvendo pacientes críticos adultos. Tais evidências destacam que os graus III-IV da AGI associaram-se a maior mortalidade entre 28 e 60 dias, sendo o escore SOFA um preditor independente. A mortalidade esteve relacionada à intolerância alimentar na primeira semana de internação. Desfechos desfavoráveis correlacionaram-se com menor ingestão calórica de nutrição enteral e maior prevalência de volume residual gástrico elevado em pacientes com AGI mais grave. Houve associação entre níveis plasmáticos reduzidos de citrulina e glutamina e maior prevalência de AGI, enquanto pH, IL-10 e sIgA configuraram-se como preditores independentes de falência gastrointestinal. Níveis elevados de HBP associaram-se ao desenvolvimento de INE. Os indicadores da ultrassonografia transabdominal demonstraram capacidade preditiva para INE, além de predizer independentemente a mortalidade em 28 dias. O Gastrointestinal Dysfunction Score foi desenvolvido para fornecer uma avaliação objetiva da DFGI e manter a capacidade preditiva para mortalidade em 28 e 90 dias. Os achados indicam que a DFGI e a INE, condições complexas e multifatoriais, são altamente prevalentes e associadas a desfechos desfavoráveis. Assim, ressalta-se a necessidade de novos estudos para melhor compreensão dos fatores de risco e definição de protocolos destinados à terapia nutricional enteral, para melhorar a sobrevida e os desfechos clínicos desses pacientes.
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