Hiperalimentação enteral em traumatismos crânio-encefálicos agudos reposição ou dietoterapia?

Schelp, Arthur; Pellizon, Angela; Burini, Roberto

doi:10.1590/S0004-282X1992000200013

Resumos

Os autores apresentam revisão geral sobre a fisiopatogenia do trauma, ressaltando os estados de hipereatabolismo e hipermetabolismo, suas consequências nutricionais, com as particularidades do trauma encefálico. São feitas, também, considerações sobre as vias, composição e volumes das dietas enterais a serem administradas a pacientes com trauma agudo encefálico, assim como são apontadas questões a serem melhor elucidadas.

trauma crânio-encefálico; metabolismo; alimentação oral

The authors raise a discussion on nutritional needs of severely traumatized patients under the currently knowledges about the pathophysiology of trauma, particularly in head injury patients. Special attention to the hypermetabolic and hypercatabolic states is given. Some considerations about dietary glucose and protein interactions are made. Finally, the authors expose the diet composition currently used in their institution. Routes and volumes for diet administration are commented. Questions about further studies in some areas of this field are also stated.

head injury; metabolism; enteral feeding

Arthur Schelp^I; Angela Pellizon^II; Roberto Burini^III

^IMédico, Aluno do Curso de Pós-Graduação em Patologia, Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Botucatu

^IINutricionista, Diretora do Serviço de Nutrição e Dietética, Hospital das Clínicas, UNESP

^IIIProfessor Titular, Departamento de Clínica Médica, UNESP, Faculdade de Medicina, Botucatu

RESUMO

Os autores apresentam revisão geral sobre a fisiopatogenia do trauma, ressaltando os estados de hipereatabolismo e hipermetabolismo, suas consequências nutricionais, com as particularidades do trauma encefálico. São feitas, também, considerações sobre as vias, composição e volumes das dietas enterais a serem administradas a pacientes com trauma agudo encefálico, assim como são apontadas questões a serem melhor elucidadas.

Palavras chave: trauma crânio-encefálico, metabolismo, alimentação oral.

SUMMARY

The authors raise a discussion on nutritional needs of severely traumatized patients under the currently knowledges about the pathophysiology of trauma, particularly in head injury patients. Special attention to the hypermetabolic and hypercatabolic states is given. Some considerations about dietary glucose and protein interactions are made. Finally, the authors expose the diet composition currently used in their institution. Routes and volumes for diet administration are commented. Questions about further studies in some areas of this field are also stated.

Key words: head injury, metabolism, enteral feeding.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Agradecimento Os autores agradecem ao secretário Francisco José Burzaca, pelo meticuloso auxílio na montagem e apresentação do estudo.

Dr. Arthur Oscar Schelp UNESP, Rubião Júnior - Caixa Postal 568 - 18610 Botucatu SP -Brasil.

1. Bivins BS, Twyman DL, Young AB. Failure of nonprotein calories to mediate protein conservation in brain injured patients. J Traum 1986, 26:980-986.
2. Black PR, Brooks DC, Bessey PQ, Wolfe RR, Wilmore DW. Mechanism of insulin resistance following injury. Ann Surg 1982, 196:420-485.
3. Bower RH, Muggin-Sullan M, Vallgreen S, Fischer J. Branched chain aminoacid-enri-ched solutions in the septic patient: a randomised prospective trial. Ann Surg 1986, 203:13-21.
4. Cerra FB, Blackburn G, Hirsch J, Müllen K, Zuther W. The effect of stress zevol, ami-noacid formula and nitrogen dose on nitrogen: retention in traumatic and septic stress. Ann Surg 1987. 206:282-287.
5. Cerra FB, Mazuiti J, Chute E. Branched chain metabolic support. Ann Surg 1984, 199:286-291.
6. Clifton GL, Robertson CS, Content CF. Enteral hyperalimentation in head injury. J Neurosurg 1985, 62:186-193.
7. Clifton GL, Robertson CS, Grossman RG, Hudge S, Foltz R, Garza C. The metabolic response to severe head injury. J Neurosurg 1984, 60:687-696.
8. Cuthbertson DP. Observations on the disturbance of metabolism produced by injury to the limbs. Q J Med 1932, 1:233-246.
9. Duke JH, Jorgensen SB, Broell JR, Long CL, Kinney JM. Contribution of protein to caloric expenditure following injury. Surgery 1970, 68:168-174.
10. Elwyn, DH, Kinney JM, Jeevanandam M, Gump FE, Broell JR. Influence of increasing, carbohydrate intake on glucose kinetics in injured patients. Ann Surg 1979, 190: 117-127.
11. Gadisseux P, Ward JD, Young HF, Becker DP. Nutrition and the neurosurgical patient. J Neurosurg 1984, 560:219-232.
12. Jeejeebhoy KN, Anderson GH, Nakhooda AF et al. Metabolic studies in total parenteral nutrition with lipid in man: comparison with glucose. J Clin Invest 1976, 57:125-136.
13. Jeevanandam M, Lowry SF, Brennan MF. Protein synthesis efficiency and the route of nutrient administration in man. Clin Nutr 1987, 6:233-240.
14. Jeevanandam M, Young DH, Ramias J, Schiller WR. Effect of major trauma on plasma free aminoacid concentrations in geriatric patients. Am J Clin Nutr 1990, 51:1040-1045.
15. Jeevanandam M, Young DH, Schiller WR. Endogenous protein-synthesis: efficiency in trauma vitctims. Metabolism 1989, 38:967-973.
16. Jeevanandam M, Young DH, Schiller WR. Glucose turnover, oxidation, and indices of recycling in severely traumatized patients. J Traum 1990, 30:582-589.
17. Jones DC, Rich AJ, Wright PD, Johnston IDA. Comparison of proprietary elemental and whole-protein diets in unconscious patients with head injury. Br Med J 1980, 1493-1495.
18. Kusdk KA, Stone JM, Carpenter G, Shelson GF. Effects of enteral and parenteral feeding of malnourished rats on body composition. J Traum 1982, 22:904-910.
19. Meyer JS, Stoica E, Pascu I, Shimazu K, Hartmann A. Cathecolamine concentrations in CSF and plasma of patients with cerebral infarction and hemorrhage. Brain 1973, 96:277-288.
20. Mullen JL, Gordon PB, Matthews DC, Smale BF, Rosato EF. Reduction of operative mortality by combined preoperative and postoperative nutritional support. Ann Surg 1980, 192:604-613.
21. O'Keefe SJD, Moldawer LL, Young VR, Blackburn GL. The influence of intravenous nutrition on protein dynamics following surgery. Metabolism 1981, 30:1150-1158.
22. Rapp RP, Pharm D, Byron Y, Twyman D, Bivins BA, Haack D, Tibbs PA, Bean JR. The favorable effect of early parenteral feeding on survival in head-injured patients. J Neurosurg 1983, 58:906-912.
23. Toyoda M, Meyer JS. Effects of cerebral ischemia, seizures and anoxia on arterial concentrations of catecholamines. Cardiovasc Res Cent Bull Houston 1979, 8:59-74.

Hiperalimentação enteral em traumatismos crânio-encefálicos agudos reposição ou dietoterapia?

Enteral feeding in acute head injury: replacement or therapy?

Datas de Publicação

Publicação nesta coleção
22 Fev 2011
Data do Fascículo
Jun 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Bivins BS, Twyman DL, Young AB. Failure of nonprotein calories to mediate protein conservation in brain injured patients. J Traum 1986, 26:980-986.

[2] 2. Black PR, Brooks DC, Bessey PQ, Wolfe RR, Wilmore DW. Mechanism of insulin resistance following injury. Ann Surg 1982, 196:420-485.

[3] 3. Bower RH, Muggin-Sullan M, Vallgreen S, Fischer J. Branched chain aminoacid-enri-ched solutions in the septic patient: a randomised prospective trial. Ann Surg 1986, 203:13-21.

[4] 4. Cerra FB, Blackburn G, Hirsch J, Müllen K, Zuther W. The effect of stress zevol, ami-noacid formula and nitrogen dose on nitrogen: retention in traumatic and septic stress. Ann Surg 1987. 206:282-287.

[5] 5. Cerra FB, Mazuiti J, Chute E. Branched chain metabolic support. Ann Surg 1984, 199:286-291.

[6] 6. Clifton GL, Robertson CS, Content CF. Enteral hyperalimentation in head injury. J Neurosurg 1985, 62:186-193.

[7] 7. Clifton GL, Robertson CS, Grossman RG, Hudge S, Foltz R, Garza C. The metabolic response to severe head injury. J Neurosurg 1984, 60:687-696.

[8] 8. Cuthbertson DP. Observations on the disturbance of metabolism produced by injury to the limbs. Q J Med 1932, 1:233-246.

[9] 9. Duke JH, Jorgensen SB, Broell JR, Long CL, Kinney JM. Contribution of protein to caloric expenditure following injury. Surgery 1970, 68:168-174.

[10] 10. Elwyn, DH, Kinney JM, Jeevanandam M, Gump FE, Broell JR. Influence of increasing, carbohydrate intake on glucose kinetics in injured patients. Ann Surg 1979, 190: 117-127.

[11] 11. Gadisseux P, Ward JD, Young HF, Becker DP. Nutrition and the neurosurgical patient. J Neurosurg 1984, 560:219-232.

[12] 12. Jeejeebhoy KN, Anderson GH, Nakhooda AF et al. Metabolic studies in total parenteral nutrition with lipid in man: comparison with glucose. J Clin Invest 1976, 57:125-136.

[13] 13. Jeevanandam M, Lowry SF, Brennan MF. Protein synthesis efficiency and the route of nutrient administration in man. Clin Nutr 1987, 6:233-240.

[14] 14. Jeevanandam M, Young DH, Ramias J, Schiller WR. Effect of major trauma on plasma free aminoacid concentrations in geriatric patients. Am J Clin Nutr 1990, 51:1040-1045.

[15] 15. Jeevanandam M, Young DH, Schiller WR. Endogenous protein-synthesis: efficiency in trauma vitctims. Metabolism 1989, 38:967-973.

[16] 16. Jeevanandam M, Young DH, Schiller WR. Glucose turnover, oxidation, and indices of recycling in severely traumatized patients. J Traum 1990, 30:582-589.

[17] 17. Jones DC, Rich AJ, Wright PD, Johnston IDA. Comparison of proprietary elemental and whole-protein diets in unconscious patients with head injury. Br Med J 1980, 1493-1495.

[18] 18. Kusdk KA, Stone JM, Carpenter G, Shelson GF. Effects of enteral and parenteral feeding of malnourished rats on body composition. J Traum 1982, 22:904-910.

[19] 19. Meyer JS, Stoica E, Pascu I, Shimazu K, Hartmann A. Cathecolamine concentrations in CSF and plasma of patients with cerebral infarction and hemorrhage. Brain 1973, 96:277-288.

[20] 20. Mullen JL, Gordon PB, Matthews DC, Smale BF, Rosato EF. Reduction of operative mortality by combined preoperative and postoperative nutritional support. Ann Surg 1980, 192:604-613.

[21] 21. O'Keefe SJD, Moldawer LL, Young VR, Blackburn GL. The influence of intravenous nutrition on protein dynamics following surgery. Metabolism 1981, 30:1150-1158.

[22] 22. Rapp RP, Pharm D, Byron Y, Twyman D, Bivins BA, Haack D, Tibbs PA, Bean JR. The favorable effect of early parenteral feeding on survival in head-injured patients. J Neurosurg 1983, 58:906-912.

[23] 23. Toyoda M, Meyer JS. Effects of cerebral ischemia, seizures and anoxia on arterial concentrations of catecholamines. Cardiovasc Res Cent Bull Houston 1979, 8:59-74.