RESUMO
The aim of this study was to systematically review the effect of permissive underfeeding/trophic feeding on the clinical outcomes of critically ill patients. A systematic review of randomized clinical trials to evaluate the mortality, length of stay, and mechanical ventilation duration in patients randomized to either hypocaloric or full-energy enteral nutrition was performed. Data sources included PubMed and Scopus and the reference lists of the articles retrieved. Two independent reviewers participated in all phases of this systematic review as proposed by the Cochrane Handbook, and the review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 7 randomized clinical trials that included a total of 1,717 patients were reviewed. Intensive care unit length of stay and mechanical ventilation duration were not statistically different between the intervention and control groups in all randomized clinical trials, and mortality rate was also not different between the groups. In conclusion, hypocaloric enteral nutrition had no significantly different effects on morbidity and mortality in critically ill patients when compared with full-energy nutrition. It is still necessary to determine the safety of this intervention in this group of patients, the optimal amount of energy provided, and the duration of this therapy.
Assuntos
Cuidados Críticos , Estado Terminal/terapia , Nutrição Enteral , Estado Nutricional , Humanos , Tempo de Internação , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial , Resultado do TratamentoRESUMO
INTRODUCTION: Our aim was to evaluate the impact of hyperproteic hypocaloric enteral feeding on clinical outcomes in critically ill patients, particularly on severity of organic failure measured with the Sequential Organ Failure Assessment (SOFA). MATERIALS AND METHODS: In a double blind clinical trial, 80 critically ill adult patients were randomized to hyperproteic hypocaloric or to isocaloric enteral nutrition; all patients completed follow-up of at least 4 days. Prescribed caloric intake was: Hyperproteic hypocaloric enteral nutrition (15 kcal/kg with 1.7 g/kg of protein) or isocaloric enteral nutrition (25 kcal/kg with 20% of the calories as protein). The main outcome was the differences in delta SOFA at 48 h. Secondary outcomes were intensive care unit (ICU) length of stay, days on ventilator, hyperglycemic events, and insulin requirements. RESULTS: There were no differences in SOFA score at baseline (7.5 (standard deviation (SD) 2.9) vs 6.7 (SD 2.5) P = 0.17). The total amount of calories delivered was similarly low in both groups (12 kcal/kg in intervention group vs 14 kcal/kg in controls), but proteic delivery was significantly different (1.4 vs 0.76 g/kg, respectively P ≤ 0.0001). The intervention group showed an improvement in SOFA score at 48 h (delta SOFA 1.7 (SD 1.9) vs 0.7 (SD 2.8) P = 0.04) and less hyperglycemic episodes per day (1.0 (SD 1.3) vs 1.7 (SD 2.5) P = 0.017). DISCUSSION: Enteral hyperproteic hypocaloric nutrition therapy could be associated with a decrease in multiple organ failure measured with SOFA score. We also found decreased hyperglycemia and a trend towards less mechanical ventilation days and ICU length of stay.
RESUMO
Feed shortages are relatively frequent in subtropical pasture-based dairy production systems. The effect of feed restriction on milk yield and physical-chemical traits was evaluated in this study. The experiment was carried out in Brazil's south region. Treatments consisted of control and restricted diet. Six multiparous and six primiparous cows, with 499 ± 47.20 kg body weight (BW), at mid-lactation (188 ± 124 days in milk), producing 19.35 ± 4.10 kg of milk were assigned to two groups, balanced for parity, each group receiving a different sequence of the dietary treatments for 56 days, in a crossover design. Diet nominated as control included 8 kg DM 100 kg BW-1 of Bermuda grass var. Tifton pasture (Cynodon dactylon (L.) Pers.), 5.00 kg of concentrate and 2.50 kg of Tifton hay per day. The restriction diet consisted of 50 % of the quantity offered in the control diet. Milk production and physicochemical composition were evaluated. Feed restriction reduced milk production by 40 %, body condition score by 5 %, milk magnesium by 14.3 %, lactose by 1.7 %, titratable acidity by 10 % and stability to the ethanol test by 9 % and it tended to increase (7 %) milk potassium content. No changes were found for the remaining characteristics. Since feed restriction is quite frequent in Brazil's extensive dairy production systems, our concern is that besides decreased milk production, changes can occur in the physiochemical attributes of the milk, mainly a reduction in the stability to the ethanol test, which may increase the volume of milk rejected by the industry.
RESUMO
Feed shortages are relatively frequent in subtropical pasture-based dairy production systems. The effect of feed restriction on milk yield and physical-chemical traits was evaluated in this study. The experiment was carried out in Brazil's south region. Treatments consisted of control and restricted diet. Six multiparous and six primiparous cows, with 499 ± 47.20 kg body weight (BW), at mid-lactation (188 ± 124 days in milk), producing 19.35 ± 4.10 kg of milk were assigned to two groups, balanced for parity, each group receiving a different sequence of the dietary treatments for 56 days, in a crossover design. Diet nominated as control included 8 kg DM 100 kg BW-1 of Bermuda grass var. Tifton pasture (Cynodon dactylon (L.) Pers.), 5.00 kg of concentrate and 2.50 kg of Tifton hay per day. The restriction diet consisted of 50 % of the quantity offered in the control diet. Milk production and physicochemical composition were evaluated. Feed restriction reduced milk production by 40 %, body condition score by 5 %, milk magnesium by 14.3 %, lactose by 1.7 %, titratable acidity by 10 % and stability to the ethanol test by 9 % and it tended to increase (7 %) milk potassium content. No changes were found for the remaining characteristics. Since feed restriction is quite frequent in Brazil's extensive dairy production systems, our concern is that besides decreased milk production, changes can occur in the physiochemical attributes of the milk, mainly a reduction in the stability to the ethanol test, which may increase the volume of milk rejected by the industry.