Avaliação da Massa Muscular e Suporte Nutricional no Doente Crítico

Autores

DOI:

https://doi.org/10.24950/rspmi.2022.01.220

Palavras-chave:

Cuidados Intensivos, Doente Crítico, Músculo Esquelético, Suporte Nutricional, Ultrassonografia

Resumo

Introdução: A perda de massa muscular é um problema cada vez mais prevalente em doentes críticos, estando fortemente relacionada com o seu prognóstico e com a qualidade de vida após a saída da unidade de cuidados intensivos. Pretendeu-se com este estudo avaliar a perda da massa muscular nos primeiros cinco dias de internamento, e se existia uma correlação entre esta e o suporte nutricional fornecido aos doentes.

Métodos: Estudo prospetivo observacional entre janeiro e março de 2020 num serviço de cuidados intensivos. No dia de admissão e no quinto dia de internamento procedeu-se à avaliação ecográfica da espessura da massa muscular do bíceps braquial e do quadríceps femoral. Durante o período de cinco dias também se analisou o suporte nutricional energético e proteico.

Resultados: Avaliaram-se 35 doentes com idade média de 64±15 anos, maioritariamente do género masculino (62,9%). A espessura da massa muscular foi avaliada com recurso à ecografia, tendo-se obtido uma perda de 1,77 mm na espessura do bíceps braquial e 2,19 mm no quadríceps femoral. Os doentes receberam um suporte nutricional correspondente a 20,00% das suas necessidades proteicas e 24,94% das suas necessidades energéticas estimadas.

Conclusão: É possível avaliar de forma rápida, objectiva e não invasiva a massa muscular do doente crítico e verificou-se a perda significativa de massa muscular na fase inicial do internamento. O suporte nutricional fornecido foi consideravelmente inferior às recomendações.

Downloads

Não há dados estatísticos.

Referências

Puthucheary Z, Montgomery H, Moxham J, Harridge S, Hart N. Structure to function: Muscle failure in critically ill patients. J Physiol. 2010;588:4641– 8.

Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310:1591– 600. doi: 10.1001/jama.2013.278481.

Tillquist M, Kutsogiannis DJ, Wischmeyer PE, Kummerlen C, Leung R, Stollery D, et al. Bedside ultrasound is a practical and reliable measurement tool for assessing quadriceps muscle layer thickness. J Parenter Enter Nutr. 2014;38:886–90.

Cartwright MS, Kwayisi G, Griffin LP, Sarwal A, Walker FO, Harris JM, et al. Quantitative neuromuscular ultrasound in the intensive care unit. Muscle and Nerve. 2013;47:255–9.

Joskova V, Patkova A, Havel E, Najpaverova S, Uramova D, Kovarik M, et al. Critical evaluation of muscle mass loss as a prognostic marker of morbidity in critically ill patients and methods for its determination. J Rehabil Med. 2018;50:696–704.

Dusseaux MM, Antoun S, Grigioni S, Béduneau G, Carpentier D, Gi rault C, et al. Skeletal muscle mass and adipose tissue alteration in critically ill patients. PLoS One. 2019;14:e0216991. doi: 10.1371/journal. pone.0216991.

Maramattom BV, Wijdicks EFM. Acute neuromuscular weakness in the intensive care unit. Crit Care Med. 2006;34(11):2835–41.

Lodeserto F, Yende S. Understanding skeletal muscle wasting in critically ill patients. Crit Care. 2014;18:1–3.

Deutz NEP, Ashurst I, Ballesteros MD, Bear DE, Cruz-Jentoft AJ, Genton L, et al. The Underappreciated Role of Low Muscle Mass in the Management of Malnutrition. J Am Med Dir Assoc. 2019;20:22–7.

Moisey LL, Mourtzakis M, Cotton BA, Premji T, Heyland DK, Wade CE, Bulger E, Kozar RA; Nutrition and Rehabilitation Investigators Consortium (NUTRIC). Skeletal muscle predicts ventilator-free days, ICU-free days, and mortality in elderly ICU patients. Crit Care. 2013;17:R206. doi: 10.1186/ cc12901.

Cerra FB, Benitez MR, Blackburn GL, Irwin RS, Jeejeebhoy K, Katz DP, et al. Applied nutrition in ICU patients: A consensus statement of the Ameri can College of Chest Physicians. Chest. 1997;111:769–78.

Lambell KJ, Tatucu-Babet OA, Chapple LA, Gantner D, Ridley EJ. Nutrition therapy in critical illness: a review of the literature for clinicians. Crit Care. 2020;24:35. doi: 10.1186/s13054-020-2739-4.

Segaran E, Wandrag L, Stotz M, Terblanche M, Hickson M. Does body mass index impact on muscle wasting and recovery following critical illness? A pilot feasibility observational study. J Hum Nutr Diet. 2017;30:227– 35.

McClave SA, Taylor BE, Martindale RG, Patel J, Rice TW, Braunschweig C, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enter Nutr. 2016;40:159–211.

Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38:48–79. doi:10.1016/j.clnu.2018.08.037

Prado CMM, Heymsfield SB. Lean tissue imaging: A new era for nutritional assessment and intervention. J Parenter Enter Nutr. 2014;38:940–53.

Paris MT, Mourtzakis M, Day A, Leung R, Watharkar S, Kozar R, et al. Validation of Bedside Ultrasound of Muscle Layer Thickness of the Quadriceps in the Critically Ill Patient (VALIDUM Study). J Parenter Enter Nutr. 2017;41:171–80.

Campbell IT, Watt T, Withers D, England R, Sukumar S, Keegan MA, et al. Muscle thickness, measured with ultrasound, may be an indicator of leantissue wasting in multiple organ failure in the presence of edema. Am J Clin Nutr. 1995;62:533–9.

Gruther W, Benesch T, Zorn C, Paternostro-Sluga T, Quittan M, Fialka- -Moser V, et al. Muscle wasting in intensive care patients: Ultrasound observation of the M. quadriceps femoris muscle layer. J Rehabil Med. 2008;40:185–9.

Prado CM, Purcell SA, Alish C, Pereira SL, Deutz NE, Heyland DK, et al. Implications of low muscle mass across the continuum of care: a narrative review. Ann Med. 2018;50:675–93. doi:10.1080/07853890.2018.1511918

Nijholt W, Scafoglieri A, Jager-Wittenaar H, Hobbelen JS, van der Schans CP. The reliability and validity of ultrasound to quantify muscles in older adults: a systematic review. J Cachexia Sarcopenia Muscle. 2017;8:702– 12.

Simpson F, Doig GS. Physical assessment and anthropometric measures for use in clinical research conducted in critically ill patient populations: An analytic observational study. J Parenter Enter Nutr. 2015;39:313–21.

Nakanishi N, Oto J, Tsutsumi R, Iuchi M, Onodera M, Nishimura M. Upper and lower limb muscle atrophy in critically ill patients: an observational ultrasonography study. Intensive Care Med. 2018;44:263–4.

Rustani K, Kundisova L, Capecchi PL, Nante N, Bicchi M. Ultrasound measurement of rectus femoris muscle thickness as a quick screening test for sarcopenia assessment. Arch Gerontol Geriatr. 2019;83:151-4. doi: 10.1016/j.archger.2019.03.021.

Weinel LM, Summers MJ, Chapple LA. Ultrasonography to measure quadriceps muscle in critically ill patients: A literature review of reported methodologies. Anaesth Intensive Care. 2019;47:423–34.

Nakanishi N, Tsutsumi R, Okayama Y, Takashima T, Ueno Y, Itagaki T, Tsutsumi Y, Sakaue H, Oto J. Monitoring of muscle mass in critically ill patients: comparison of ultrasound and two bioelectrical impedance analysis devices. J Intensive Care. 2019;7:61. doi: 10.1186/s40560-019-0416-y.

Monk DN, Plank LD, Franch-Arcas G, Finn PJ, Streat SJ, Hill GL. Sequen tial changes in the metabolic response in critically injured patients during the first 25 days after blunt trauma. Ann Surg. 1996;223:395–405.

Reintam Blaser A, Starkopf J, Alhazzani W, Berger MM, Casaer MP, Deane AM, et al. Early enteral nutrition in critically ill patients: ESCIM clinical practice guidelines. Intensive Care Med. 2017;43:380e98.

Downloads

Publicado

22-03-2022

Como Citar

1.
Mano D, Vidal C, de Mendonça T, Sousa R, Santos M, Pinho JP, Marinho R, Marinho A. Avaliação da Massa Muscular e Suporte Nutricional no Doente Crítico. RPMI [Internet]. 22 de Março de 2022 [citado 29 de Março de 2024];29(1):13-8. Disponível em: https://revista.spmi.pt/index.php/rpmi/article/view/510

Edição

Secção

Artigos Originais

Artigos mais lidos do(s) mesmo(s) autor(es)