PATRICIA ZAMBERLAN DOS SANTOS
Projetos de Pesquisa
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Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
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- Nutritional Assessment and Body Composition in Critically Ill Children as Prognostic Indicators(2019) ZAMBERLAN, P.; CARVALHO, W.B. de; DELGADO, A.F.Purpose of review: Malnutrition is very common in critically ill patients, mainly children and adolescents, and it increases morbidity, length of stay, medical costs, and mortality. Anthropometric and body composition assessment are basic components for monitoring nutritional status. In addition, it appears to be able to predict several clinical outcomes in these patients. This review describes studies evaluating usefulness of nutritional and prognostic assessment tools in critically ill patients. Recent findings: Although anthropometry is difficult to interpret in critically ill patients, it is very useful for classifying nutrition status, as well as for planning nutritional therapy (NT) and nutrition monitoring. Several traditional nutritional markers (zinc, selenium, prealbumin, and HDL) have been used as inflammatory and, consequently, prognostic indicators. Body composition indicators as phase angle obtained by bioelectrical impedance and arm circumference have shown a strong ability to predict outcomes in a wide variety of clinical situations, including critically ill children and adolescents. Summary: Early intervention targeting nutrition assessment can prevent or minimize the complications of undernutrition in the intensive care unit. Thus, improving the accuracy of nutritional and prognostic evaluation is of paramount importance in the clinical management of critically ill patients. © 2019, Springer Nature Switzerland AG.
- The Latin American and Spanish Survey on Nutrition in Pediatric Intensive Care (ELAN-CIP2)(2019) CAMPOS-MINO, Santiago; CID, Jesus Lopez-Herce; DELGADO, Artur Figueiredo; BENAVIDES, Eliana Munoz; COSS-BU, Jorge A.; VILLAVICENCIO, Pedro Mestre; IRAMAIN, Ricardo; VILLARUEL, Sayani Valdez; NIEVA, Ana; VARGAS, Ana; LOPEZ, Pilar Arias; FERNANDEZ, Analia; SILVESTRE, Andrea; BOTTA, Priscila; TORRES, Silvio Fabio; COSTA, Caroline Abud Drumond; GARCIA, Pedro Celiny Ramos; PIVA, Jefferson; CABEDO, Maria Thereza De Cordes; LUGLIO, Michele; ZAMBERLAN, Patricia; GUZMAN, Gustavo; LOBOGUERRERO, Fanny Garcia; FERNANDEZ, Mauricio; CASSALETT, Gabriel; PEREZ, German; MONTES, Miguel Ruz; VELASQUEZ, Rocio Porras; PEREZ, Victor; CASTRO, Santiago Ramirez; VILLAVICENCIO, Pedro Mestre; WEGNER, Adriana; ORDENES, Nadia; DESSAUER, Bettina Von; CORS, Carolina; GONZALES, Marcos; BENAVIDES, Eliana Munoz; QUIROZ, Miguel Angel Saavedra; PERALTA, Felipe Verscheure; ROQUE, Jorge; ROSICH, Patricia Del Rosario; CAMPOS-MINO, Santiago; MONTALVO, Erika; PESANTES, Xavier Paez; BARQUIN, Luis Augusto Moya; RIVAS, Ricardo Alfredo Mack; ROMAN, Carlos; ORTIZ, Cesar Antonio Ramos; MONSREAL, Miguel Ignacio Flores; VILLARUEL, Sayani Valdez; GONZALEZ, Sonia Vargas; JIMENEZ, Hassel Jimmy; BRACHO, Carlos; SAMUDIO, Lissa; PALPAN, Beatriz Atachagua; PALOMO, Patricia; ESCALANTE-KANASHIRO, Raffo; ARANA, Rosa; NUNEZ, Antonio Rodriguez; CID, Jesus Lopez-Herce; FERNANDEZ, Yolanda Lopez; MENCHACA, Amanda; LOPEZ, Claudia MadridObjective: To characterize the practices of nutritional support in Latin American and Spanish PICUs. Design: Survey with a questionnaire sent to Latin American Society of Pediatric Intensive Care members. Setting: PICUs of participant hospitals. Patients: Critically ill children between 1 month and 18 years old. Interventions: None. Measurements and Main Results: Forty-seven surveys from 17 countries were analyzed. Sixty-seven percent of PICUs were from university-affiliated hospitals, with a median of 380 admissions/yr. Sixty-eight percent and 48.9% had a nutritional support team and nutritional support protocol, respectively. Seventy-five percent completed nutritional evaluations, with 34.2% at admission. PICUs with high-volume admissions were likely to have a nutritional support team (p < 0.005), and university-affiliated hospitals showed a trend of having a nutritional support team (p = 0.056). Measured, estimated, and ideal weights were used in 75%, 14.6%, and 10.4%, respectively. Energy requirements were calculated using Holliday & Segar and Schofield equations in 90% of the PICUs; 43% used correction factors. Only three PICUs had indirect calorimetry. At day 3 of initiation of nutritional support, 57.3% of PICUs provided at least 50% of the calculated energy requirement, and 91.5% at day 5. Protein needs were estimated according to American Society for Parenteral and Enteral Nutrition and European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition guidelines in 55.3% and 40.4%, respectively. Enteral nutrition was the preferred feeding method, initiated in 97.7% at 48 hours. The feeding route was gastric (82.9%), by bolus (42.5%) or continuous (57.4%). Monitoring methods included gastric residual measurement in 55.3%. Enteral nutrition was discontinued in 82.8% when gastric residual was 50% of the volume. Prokinetics were used in 68%. More than half of PICUs used parenteral nutrition, with 95.8% of them within 72 hours. Parenteral nutrition was administered by central vein in 93.6%. Undernourished children received parenteral nutrition sooner, whether or not enteral nutrition intolerance was present. When enteral nutrition was not tolerated beyond 72 hours, parenteral nutrition was started in 57.4%. Parenteral nutrition was initiated when enteral nutrition delivered less than 50% in 97%. Conclusions: Nutritional practices are heterogeneous in Latin American PICUs, but the majority use nutritional support strategies consistent with international guidelines.
- Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children(2019) ZAMBERLAN, Patricia; FEFERBAUM, Rubens; DORIA FILHO, Ulysses; CARVALHO, Werther Brunow de; DELGADO, Artur FigueiredoBackgroundNutrition markers may be useful for diagnosis and monitoring and, also, as additional indicators of estimating death risk. We tested the association of body composition indicators (mid-upper arm circumference and phase angle) with pediatric intensive care unit (PICU) length of stay and mortality in critically ill pediatric patients. MethodsData from children aged 2 months-18 years were collected, and bioelectrical impedance was performed to obtain phase angle. Severity was evaluated by scoring the Pediatric Index of Mortality. Descriptive statistics were reported for nominal variables. Receiver operating characteristic curve was used to analyze the association of phase angle with 30-day mortality and to find the best cutoff. Survival probabilities and PICU length of stay were estimated using the Kaplan-Meier method. ResultsWe evaluated 247 children with a median age of 4.8 years whose main cause of admission was sepsis. Survival curves showed higher survival in patients with phase angle >2.8 degrees compared with patients with phase angle 2.8 degrees (P<.0001). Kaplan-Meier time-to-event analysis showed that children with lower phase angle values were more likely to remain in the PICU (hazard ratio, 1.84; P=.003). Lower survival was also observed in patients who presented mid-upper arm circumference values 5th percentile (P<.03). ConclusionsMid-upper arm circumference and phase angle were associated with mortality and morbidity in critically ill children, suggesting that these parameters may be useful not only for nutrition diagnosis and monitoring, but also as an additional indicator in estimating prognosis.
- Response to ""Comment on 'Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children'""(2019) ZAMBERLAN, Patricia; CARVALHO, Werther Brunow de; DELGADO, Artur Figueiredo