Discusión de Soporte Nutricional del Paciente Adulto
A diferencia de las guías de práctica clínica, los procedimientos de consenso intentan conciliar las diferentes visiones que se tienen sobre un problema, teniendo en cuenta las condiciones propias del medio donde se desarrollan las acciones. Este documento representa las posiciones de múltiples profesionales que ejercen en instituciones de diferente carácter y en diferentes zonas geográficas del país, por lo que las conclusiones son de fácil aplicación en el contexto general y ayudan a disminuir la heterogeneidad en los tratamientos, además de ofrecer una opción para un manejo más costoefectivo de los pacientes que requieren nutrición.
Aunque en muchos de los temas se logró consenso, otros temas demostraron la variabilidad clínica existente entre profesionales que practican la nutrición. Es, entonces, función de la Asociación liderar un proceso que permita alcanzar el consenso en estos aspectos. Entre los más importantes, se deben mencionar los relacionados con la estructura de los grupos y sus procesos, lo mismo que en los indicadores y el mecanismo de evaluación del desempeño de los grupos. En el contexto actual del sistema de salud, demostrar no solo que las cosas se hacen bien, sino el efecto que esto tiene sobre los pacientes, su calidad de vida y sobre las finanzas del sistema, es absolutamente necesario para garantizar la supervivencia y el desarrollo de los grupos de nutrición clínica. También, es relevante sugerir mecanismos que motiven a los diferentes profesionales implicados a participar en reuniones de actualización y a realizar investigación que permita mejorar progresivamente la calidad del cuidado nutricional en el país.
Nutritional support in the adult. Consensus meeting of the Colombian Association of Clinical Nutrition
Abstract
Introduction: Nutritional support is the only therapeutic strategy for patients with difficulties in food ingestion. This document tries to unify concepts about nutrition in adults and to develop a simple and easy to consult tool.
Material and methods: A consensus development method was chosen. The Colombian Association for Clinical Nutrition selected experts based on their leadership in nutritional support groups, their profession and place of work. Twenty five people answered the surveys and three groups were assembled: one to define the structure of nutritional support groups, to calculate caloric requirements; and to discuss enteral and parenteral access methods. Question about each subject were previously defined and the answers were categorized. After three rounds, the consensus method was closed.
Results: It was possible to attain a consensus on the necessity to have nutritional support group to manage adults patients with enteral or parenteral nutrition|; the group should include a physician, a nutritionist, a nurse and pharmaceutical chemist with specific functions; patients should be assessed daily; the HarrisBenedict formula should be used to calculate energy requirements; protein, fat and caloric contribution doses; enteral tube should be made of silicone or polyurethane; indications of enteral tubes; indication of duodenal tubes; indication of percutaneous endoscopic gastrostomy as the definitive way of enteral nutrition; time to begin enteral nutrition; management of enteral tubes for medicine administration; indications of parenteral nutrition; use of central vein catheter and dressings; way and place of catheter insertion and time of change.
Conclusion: There are recommendations in nutritional support that are widely accepted and allow a standardization of processes.
Key words: consensus development conference; nutrition personnel; nutrition programs; enteral nutrition; parenteral nutrition, total.
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Correspondencia: Charles Bermúdez, MD, MSc (C.)
Correo electrónico: chebermud@yahoo.com
Bogotá, D.C., Colombia
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