Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Yoğun Bakım Hastalarında Erken Nütrisyonel Destek Tedavisinin Hastane Yatış Süresi ve Erken Oral Nütrisyona Geçiş Süresine Etkisi: Retrospektif Kohort
The Effect of Early Nutritional Support Treatment in Intensive Care Patients on Duration of Hospitalization and Early Transition to Oral Nutrition: Retrospective Cohort
Esra FİDANa, Z. Işık Solak GÖRMÜŞb, E. Filiz SEVENc, Burçin AKHANd, Süleyman DÖNMEZe
aKonya Numune Hastanesi, Beslenme ve Diyetetik Kliniği, Konya, TÜRKİYE
bNecmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Fizyoloji ABD, Konya, TÜRKİYE
cKonya Numune Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, Konya, TÜRKİYE
dKonya Numune Hastanesi, Nütrisyon Birimi, Konya, TÜRKİYE
eKonya Numune Hastanesi, Deri ve Zührevi Hastalıklar Kliniği, Konya, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2022;7(1):43-50
doi: 10.5336/healthsci.2021-82859
Article Language: TR
Full Text
ÖZET
 Amaç: Çalışma, hastane yoğun bakımlarında kanser tedavisi haricinde tedavi alan ve nütrisyon birimine konsülte edilen hastalarda, iyatrojenik malnütrisyonun erken teşhisi ve tedavisi; erken nütrisyonel destek tedavi başlanmasının, hastaların hastanede kalış süreleri üzerine etkisi, oral nütrisyona geçiş süresinin kısaltılması üzerine etkisi hususunda durum belirlemek amacıyla yapılmıştır. Gereç ve Yöntemler: Araştırmada, Ocak 2018 ve Aralık 2019 yıllarında Konya Numune Hastanesi 1, 2 ve 3. basamak yoğun bakım ünitelerinde yatan hastalara ait veriler kullanılmıştır. 20 yaş ve üzeri, kanser tanısı olmayan, 3 gün ve üzeri yoğun bakımda tedavi gören ve nütrisyon birimine konsülte edilen tüm hastalar değerlendirilmiş ve 274 kişinin verileri kullanılarak retrospektif kohort araştırması yapılmıştır. Hastanenin nütrisyon takip formlarından hasta bilgileri alınarak Excel sistemine kaydedilmiş ve istatistiksel olarak değerlendirilmiştir. İstatistiksel analizler için SPSS testi kullanılmıştır. Bulgular: Hastaların taburculuk ya da eksitus (ex) olmaları ile diğer değişkenler kıyaslandığında, yatış sonrası parenteral beslenme kullanım günü, enteral beslenmeye başlanma günü, yatış sonrası perkütan endoskopik gastrostomi açılma günü arttıkça, hastaların ex olma sıklığının anlamlı şekilde arttığı gözlenmiştir. Yatış sonrası nütrisyon birimine yönlendirmenin geciktiği hastalarda, enteral beslenmeye başlanma gününün ve oral beslenmeye geçiş süresinin uzadığı belirlenmiştir. Enteral beslenme ürün veriliş yöntemlerinin, oral beslenmeye geçiş hızı üzerindeki etkileri kıyaslandığında, yalnızca nazogastrik beslenmeye kıyasla nazogastrik-oral besin alan hastaların oral beslenmeye geçiş sürelerinin uzadığı gözlenmiştir. Sonuç: Yoğun bakım hastalarında erken enteral nütrisyon tedavisinin, iyatrojenik malnütrisyonun erken teşhisi ve tedavisi, hastaların yoğun bakım servislerinde kalış süreleri ve oral nütrisyona geçiş süresinin kısaltılması üzerinde olumlu etkileri nedeniyle bütün yoğun bakım hastaları için önerilebilir.

Anahtar Kelimeler: Yoğun bakım; enteral beslenme; malnütrisyon
ABSTRACT
 Objective: The study focused on the early diagnosis and treatment of iatrogenic malnutrition in hospital intensive care units in patients who received treatment other than cancer treatment and were consulted to the nutrition unit; This study was conducted to determine the status of the effect of initiating early nutritional support treatment on the duration of hospital stay and shortening the transition period to oral nutrition. Material and Methods: In the study, data from patients hospitalized in Konya Numune Hospital 1st, 2nd and 3rd level intensive care units in January 2018 and December 2019 were used. All patients aged 20 and over, without cancer diagnosis, treated in the intensive care unit for 3 days or more, and consulted to the nutrition unit, were evaluated and a retrospective cohort study was conducted using the data of 274 individuals. Patient information was obtained from the nutrition follow-up forms of the hospital, recorded in the Excel system and evaluated statistically. SPSS test was used for statistical analysis. Results: When the patients were discharged or died (ex) and other variables were compared, it was observed that the frequency of death of the patients increased significantly as the day of use of parenteral nutrition after hospitalization, the day of initiation of enteral nutrition, and the day of opening percutaneous endoscopic gastrostomy after hospitalization increased. It has been determined that the days of initiation of enteral feeding and the time of transition to oral feeding are prolonged in patients in whom referral to the nutrition unit is delayed after hospitalization. When the effects of enteral nutrition product delivery methods on the rate of transition to oral feeding were compared, it was observed that the transition time to oral feeding was prolonged in patients who received nasogastric-oral nutrients compared to nasogastric feeding alone. Conclusion: Early enteral nutrition therapy in intensive care patients can be recommended for all intensive care patients due to its positive effects on early diagnosis and treatment of iatrogenic malnutrition, shortening the length of stay of patients in intensive care units and the transition to oral nutrition.

Keywords: Intensive care; enteral nutrition; malnutrition
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