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Pimenta GP, Dandin O, Caporossi C, Aguilar Nascimento JE. RESIDUAL GASTRIC VOLUME IN MORBIDLY OBESE DIABETICS AFTER AN OVERNIGHT FASTING OR 3 HOURS OF A CARBOHYDRATE-ENRICHED SUPPLEMENT: A RANDOMIZED CROSSOVER PILOT STUDY. Arq Bras Cir Dig 2024; 36:e1791. [PMID: 38324852 PMCID: PMC10841525 DOI: 10.1590/0102-672020230073e1791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/08/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND To reduce the risk of regurgitation during anesthesia for elective procedures, residual gastric volumes (RGV) have traditionally been minimized by overnight fasting. Prolonged preoperative fasting presents some adverse consequences and has been abandoned for most surgical procedures, except for obese and/or diabetic patients. AIMS The aim of this study was to assess the RGV in morbidly obese diabetic patients after traditional or abbreviated fasting. METHODS This study was approved by the Ethics Committee for Research with Human Beings from the Federal University of Mato Grosso, under number 179.017/2012. This is a prospective, randomized, and crossover design study in eight morbidly obese type II diabetic patients. RGV was measured endoscopically after either traditional overnight fasting of at least 8 hours, or after abbreviated fasting of 6 hours for solids and 3 hours for a drink containing water plus 25 g (12.5%) of maltodextrin. Data were expressed as mean and range and differences were compared with paired t-tests at p<0.05. RESULTS The study population had a mean age of 41.5 years (28-53), weight of 135 kg (113-196), body mass index of 48.2 kg/m2 (40-62.4), and type II diabetes for 4.5 years (1-10). The RGV after abbreviated fasting was 21.5 ml (5-40) vs 26.3 ml (7-65) after traditional fasting. This difference was not significant (p=0.82). CONCLUSIONS Gastric emptying in morbidly obese diabetic patients is similar after either traditional or abbreviated fasting with a carbohydrate drink.
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Affiliation(s)
| | | | - Cervantes Caporossi
- Universidade de Varzea Grande, Department of Surgery - Varzea Grande (MT), Brazil
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Aguilar-Nascimento JED, Bicudo-Salomão A, Ribeiro MRR, Dock-Nascimento DB, Caporossi C. COST-EFFECTIVENESS OF THE USE OF ACERTO PROTOCOL IN MAJOR DIGESTIVE SURGERY. Arq Bras Cir Dig 2022; 35:e1660. [PMID: 35766605 PMCID: PMC9265702 DOI: 10.1590/0102-672020210002e1660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/25/2022] [Indexed: 12/05/2022]
Abstract
Hospital costs in surgery constitute a burden for the health system in all over
the world. Multimodal protocols such as the ACERTO project enhance postoperative
recovery.
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Affiliation(s)
- José Eduardo de Aguilar-Nascimento
- Departamento de Clinica Cirúrgica do Hospital Universitário Júlio Muller da Universidade Federal de Mato Grosso - MT, Brazil.,Pós-Graduação em Ciências da Saúde da Faculdade de Medicina da Universidade Federal de Mato Grosso - MT, Brazil
| | - Alberto Bicudo-Salomão
- Departamento de Clinica Cirúrgica do Hospital Universitário Júlio Muller da Universidade Federal de Mato Grosso - MT, Brazil
| | - Mara Regina Rosa Ribeiro
- Professora Associada da Faculdade de Enfermagem da Universidade Federal de Mato Grosso - MT, Brazil
| | - Diana Borges Dock-Nascimento
- Pós-Graduação em Ciências da Saúde da Faculdade de Medicina da Universidade Federal de Mato Grosso - MT, Brazil.,Professora Associada da Faculdade de Nutrição da Universidade Federal de Mato Grosso - MT, Brazil
| | - Cervantes Caporossi
- Departamento de Clinica Cirúrgica do Hospital Universitário Júlio Muller da Universidade Federal de Mato Grosso - MT, Brazil.,Pós-Graduação em Ciências da Saúde da Faculdade de Medicina da Universidade Federal de Mato Grosso - MT, Brazil
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DE-Aguilar-Nascimento JE, SalomÃo AB, Caporossi C, Dock-Nascimento DB, Eder Portari-Filho P, Campos ACL, Imbelloni LE, Silva-Jr JM, Waitzberg DL, Correia MITD. ACERTO Project - 15 years changing perioperative care in Brazil. Rev Col Bras Cir 2021; 48:e20202832. [PMID: 33503143 PMCID: PMC10846405 DOI: 10.1590/0100-6991e-20202832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/18/2020] [Indexed: 12/14/2022] Open
Abstract
The ACERTO project is a multimodal perioperative care protocol. Implemented in 2005, the project in the last 15 years has disseminated the idea of a modern perioperative care protocol, based on evidence and with interdisciplinary team work. Dozens of published studies, using the protocol, have shown benefits such as reduced hospital stay, postoperative complications and hospital costs. Disseminated in Brazil, the project is supported by the Brazilian College of Surgeons and the Brazilian Society of Parenteral and Enteral Nutrition, among others. This article compiles publications by the authors who belong to the CNPq research group "Acerto em Nutrição e Cirurgia", refers to the experience of other national authors in various surgical specialties, and finally outlines the evolution of the ACERTO project in the timeline.
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Affiliation(s)
- JosÉ Eduardo DE-Aguilar-Nascimento
- - Centro Universitário de Várzea Grande (UNIVAG), Direção do Curso de Medicina - Várzea Grande - MT - Brasil
- - Universidade Federal de Mato Grosso, Curso de Pós-Graduação em Ciências da Saúde - Cuiabá - MT - Brasil
| | | | - Cervantes Caporossi
- - Universidade Federal de Mato Grosso, Curso de Pós-Graduação em Ciências da Saúde - Cuiabá - MT - Brasil
| | | | - Pedro Eder Portari-Filho
- - Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Departamento de Cirurgia Geral e Especializada - Rio de Janeiro - RJ - Brasil
| | | | | | - JoÃo Manoel Silva-Jr
- - Universidade de São Paulo, Divisão de Anestesiologia - São Paulo - SP - Brasil
| | - Dan Linetzky Waitzberg
- - Universidade de São Paulo, Departamento de Gastroenterologia - São Paulo - SP - Brasil
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Ribeiro AC, Dock-Nascimento DB, Silva JM, Caporossi C, Aguilar-Nascimento JED. Hypophosphatemia and risk of refeeding syndrome in critically ill patients before and after nutritional therapy. ACTA ACUST UNITED AC 2020; 66:1241-1246. [PMID: 33027452 DOI: 10.1590/1806-9282.66.9.1241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/26/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the prevalence of hypophosphatemia as a marker of refeeding syndrome (RFS) before and after the start of nutritional therapy (NT) in critically ill patients. METHODS Retrospective cohort study including 917 adult patients admitted at the intensive care unit (ICU) of a tertiary hospital in Cuiabá-MT/Brasil. We assessed the frequency of hypophosphatemia (phosphorus <2.5mg/dl) as a risk marker for RFS. Serum phosphorus levels were measured and compared at admission (P1) and after the start of NT (P2). RESULTS We observed a significant increase (36.3%) of hypophosphatemia and, consequently, a greater risk of RFS from P1 to P2 (25.6 vs 34.9%; p<0.001). After the start of NT, malnourished patients had a greater fall of serum phosphorus. Patients receiving NT had an approximately 1.5 times greater risk of developing RFS (OR= 1.44 95%CI 1.10-1,89; p= 0.01) when compared to those who received an oral diet. Parenteral nutrition was more associated with hypophosphatemia than either enteral nutrition (p=0,001) or parenteral nutrition supplemented with enteral nutrition (p=0,002). CONCLUSION The frequency of critically ill patients with hypophosphatemia and at risk for RFS on admission is high and this risk increases after the start of NT, especially in malnourished patients and those receiving parenteral nutrition.
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Affiliation(s)
- Amanda Coelho Ribeiro
- Nutricionista, Mestre em Ciências da Saúde pelo Programa de Pós-Graduação em Ciências da Saúde da Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil
| | - Diana Borges Dock-Nascimento
- Nutricionista, Professor Doutor Associado II, Faculdade de Nutrição da UFMT, Departamento de Alimentos e Nutrição em Cuiabá-MT. Professor orientador do Programa de Pós-Graduação em Ciências da Saúde da Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil
| | - João Manoel Silva
- Médico, Professor orientador do Programa de Pós-Graduação em Anestesiologia da Universidade de São Paulo, São Paulo, SP, Brasil.,Componente do corpo clínico do Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Cervantes Caporossi
- Médico, Professor Doutor do Programa de Pós-Graduação em Ciências da Saúde da Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil
| | - José Eduardo de Aguilar-Nascimento
- Médico, Professor Doutor do Programa de Pós-Graduação em Ciências da Saúde da Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil.,Diretor do Curso de Medicina do Centro Universitário de Várzea Grande (Univag), Várzea Grande, MT, Brasil
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Nascimento M, Caporossi C, Eduardo Aguilar-Nascimento J, Michelon Castro-Barcellos H, Teixeira Motta R, Reis Lima S. Efficacy of Synbiotics to Reduce Symptoms and Rectal Inflammatory Response in Acute Radiation Proctitis: A Randomized, Double-Blind, Placebo-Controlled Pilot Trial. Nutr Cancer 2019; 72:602-609. [PMID: 31364875 DOI: 10.1080/01635581.2019.1647254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose: Evaluate whether the daily intake of synbiotics improves symptoms and rectal/systemic inflammatory response in patients with radiation-induced acute proctitis.Methods and Materials: Twenty patients who underwent three-dimensional conformal radiotherapy for prostate cancer were randomized to intake either a synbiotic powder containing Lactobacillus reuteri (108 CFU) and soluble fiber (4.3 g) or placebo. EORTC QLQ-PRT23 questionnaire was applied before the beginning of radiotherapy and after the fifth, sixth, and seventh weeks of treatment, and the sum of both the complete (proctitis symptoms plus quality of life) and partial (proctitis symptoms) scores were compared. Fecal calprotectin was measured at Day 0 and in the fourth week of treatment, and serum C-reactive protein/albumin ratio were measured in the fourth week of treatment.Results: Both the complete and partial questionnaire score (median and range) were higher in the fifth and sixth weeks in the placebo group; there was a higher increase in fecal calprotectin in the placebo group and no difference comparing CRP/albumin ratio.Conclusions: Synbiotics reduce proctitis symptoms and improve quality of life by preventing rectal inflammation during radiotherapy for prostate cancer.
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Affiliation(s)
- Mariana Nascimento
- Department of Medicine, University Center of Varzea Grande (UNIVAG), Várzea Grande, Mato Grosso, Brazil.,Department of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Cervantes Caporossi
- Department of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - José Eduardo Aguilar-Nascimento
- Department of Medicine, University Center of Varzea Grande (UNIVAG), Várzea Grande, Mato Grosso, Brazil.,Department of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | | | - Rodrigo Teixeira Motta
- Department of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Silvia Reis Lima
- Department of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
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de-Aguilar-Nascimento JE, Salomão AB, Waitzberg DL, Dock-Nascimento DB, Correa MITD, Campos ACL, Corsi PR, Portari Filho PE, Caporossi C. ACERTO guidelines of perioperative nutritional interventions in elective general surgery. Rev Col Bras Cir 2017; 44:633-648. [DOI: 10.1590/0100-69912017006003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/20/2017] [Indexed: 12/22/2022] Open
Abstract
ABSTRACT Objective: to present recommendations based on the ACERTO Project (Acceleration of Total Post-Operative Recovery) and supported by evidence related to perioperative nutritional care in General Surgery elective procedures. Methods: review of relevant literature from 2006 to 2016, based on a search conducted in the main databases, with the purpose of answering guiding questions previously formulated by specialists, within each theme of this guideline. We preferably used randomized controlled trials, systematic reviews and meta-analyzes but also selected some cohort studies. We contextualized each recommendation-guiding question to determine the quality of the evidence and the strength of this recommendation (GRADE). This material was sent to authors using an open online questionnaire. After receiving the answers, we formalized the consensus for each recommendation of this guideline. Results: the level of evidence and the degree of recommendation for each item is presented in text form, followed by a summary of the evidence found. Conclusion: this guideline reflects the recommendations of the group of specialists of the Brazilian College of Surgeons, the Brazilian Society of Parenteral and Enteral Nutrition and the ACERTO Project for nutritional interventions in the perioperative period of Elective General Surgery. The prescription of these recommendations can accelerate the postoperative recovery of patients submitted to elective general surgery, with decrease in morbidity, length of stay and rehospitalization, and consequently, of costs.
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Gomes PC, Caporossi C, Aguilar-Nascimento JE, Silva AMCD, Araujo VMTD. Residual gastric volume evaluation with ultrasonography after ingestion of carbohydrate- or carbohydrate plus glutamine-enriched beverages: a randomized, crossover clinical trial with healthy volunteers. Arq Gastroenterol 2017; 54:33-36. [PMID: 28079236 DOI: 10.1590/s0004-2803.2017v54n1-06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/22/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND - Abbreviation of preoperative fasting to 2 hours with maltodextrin (CHO)-enriched beverage is a safe procedure and may enhance postoperative recovery. Addition of glutamine (GLN) to CHO beverages may include potential benefits to the metabolism. However, by adding a nitrogenous source to CHO beverages, gastric emptying may be delayed and increase the risk of bronchoaspiration during anesthesia. OBJECTIVE - In this study of safety, we aimed at investigating the residual gastric volume (RGV) 2 hours after the intake of either CHO beverage alone or CHO beverage combined with GLN. METHODS - We performed a randomized, crossover clinical trial. We assessed RGV by means of abdominal ultrasonography (US) in 20 healthy volunteers (10 males and 10 females) after an overnight fast of 8 hours. Then, they were randomized to receive 600 mL (400 mL immediately after US followed by another 200 mL 2 hours afterwards) of either CHO (12.5% maltodextrin) or CHO-GLN (12.5% maltodextrin plus 15 g GLN). Two sequential US evaluations were done at 120 and 180 minutes after ingestion of the second dose. The interval of time between ingestion of the two types of beverages was 2 weeks. RESULTS - The mean (SD) RGV observed after 8 hours fasting (13.56±13.25 mL) did not statistically differ (P>0.05) from the RGV observed after ingesting CHO beverage at both 120 (16.32±11.78 mL) and 180 minutes (14.60±10.39 mL). The RGV obtained at 120 (15.63±18.83 mL) and 180 (13.65±10.27 mL) minutes after CHO-GLN beverage also was not significantly different from the fasting condition. CONCLUSION - The RGV at 120 and 180 minutes after ingestion of CHO beverage combined with GLN is similar to that observed after an overnight fast.
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Affiliation(s)
- Paulo Cesar Gomes
- Faculdade de Medicina, Universidade Federal de Mato Grosso, MT, Brasil
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Gava MG, Castro-Barcellos HM, Caporossi C, Aguilar-Nascimento JED. Enhanced muscle strength with carbohydrate supplement two hours before open cholecystectomy: a randomized, double-blind study. Rev Col Bras Cir 2016; 43:54-9. [DOI: 10.1590/0100-69912016001011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/28/2015] [Indexed: 01/16/2023] Open
Abstract
Objective: to investigate the effects of preoperative fasting abbreviation with oral supplementation with carbohydrate in the evolution of grip strength in patients undergoing cholecystectomy by laparotomy. Methods : we conducted a clinical, randomizeddouble blind study with adult female patients, aged 18-60 years. Patients were divided into two groups: Control Group, with fasting prescription 6-8h until the time of operation; and Intervention Group, which received prescription of fasting for solids 6-8h before surgery, but ingested an oral supplement containing 12.5% carbohydrate, six (400ml) and two (200ml) hours before theprocedure. The handgrip strength was measured in both hands in both groups, at patient's admission (6h before surgery), the immediate pre-operative time (1h before surgery) and 12-18h postoperatively. Results : we analyzed 27 patients, 14 in the intervention group and 13 in the control group. There was no mortality. The handgrip strength (mean [standard deviation]) was significantly higher in the intervention group in the three periods studied, in at least one hand: preoperatively in the dominant hand (27.8 [2.6] vs 24.1 [3.7] kg; p=0.04), in the immediate preoperative in both hands, and postoperatively in the non-dominant hand (28.5 [3.0] vs 21.3 [5.9] kg; p=0.01). Conclusion : the abbreviation of preoperative fasting to two hours with drink containing carbohydrate improves muscle function in the perioperative period.
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Zani FVB, Aguilar-Nascimento JE, Nascimento DBD, Silva AMCD, Caporossi FS, Caporossi C. Benefits of maltodextrin intake 2 hours before cholecystectomy by laparotomy in respiratory function and functional capacity: a prospective randomized clinical trial. Einstein (Sao Paulo) 2015; 13:249-54. [PMID: 26154547 PMCID: PMC4943818 DOI: 10.1590/s1679-45082015ao3251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 04/19/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the change in respiratory function and functional capacity according to the type of preoperative fasting. METHODS Randomized prospective clinical trial, with 92 female patients undergoing cholecystectomy by laparotomy with conventional or 2 hours shortened fasting. The variables measured were the peak expiratory flow, forced expiratory volume in the first second, forced vital capacity, dominant handgrip strength, and non-dominant handgrip strength. Evaluations were performed 2 hours before induction of anesthesia and 24 hours after the operation. RESULTS The two groups were similar in preoperative evaluations regarding demographic and clinical characteristics, as well as for all variables. However, postoperatively the group with shortened fasting had higher values than the group with conventional fasting for lung function tests peak expiratory flow (128.7±62.5 versus 115.7±59.9; p=0.040), forced expiratory volume in the first second (1.5±0.6 versus 1.2±0.5; p=0.040), forced vital capacity (2.3±1.1 versus 1.8±0.9; p=0.021), and for muscle function tests dominant handgrip strength (24.9±6.8 versus 18.4±7.7; p=0.001) and non-dominant handgrip strength (22.9±6.3 versus 17.0±7.8; p=0.0002). In the intragroup evaluation, there was a decrease in preoperative compared with postoperative values, except for dominant handgrip strength (25.2±6.7 versus 24.9±6.8; p=0.692), in the shortened fasting group. CONCLUSION Abbreviation of preoperative fasting time with ingestion of maltodextrin solution is beneficial to pulmonary function and preserves dominant handgrip strength.
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Brianez LR, Caporossi C, de Moura YW, Dias LA, Leal RV, de Aguilar-Nascimento JE. Gastric residual volume by magnetic ressonance after intake of maltodextrin and glutamine: a randomized double-blind, crossover study. Arq Gastroenterol 2015; 51:123-7. [PMID: 25003264 DOI: 10.1590/s0004-28032014000200010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/20/2014] [Indexed: 11/22/2022]
Abstract
CONTEXT The addition of glutamine in preoperative drinks may enhance the benefits of carbohydrate alone. OBJECTIVES To evaluate the gastric residual volume after the intake of a beverage containing carbohydrate plus glutamine. METHODS Eleven healthy volunteers (24-30 years-old) were randomized in a crossover fashion to intake 400 mL (4h before) and 200 mL (2h before) of a beverage containing either 12.5% maltodextrin (carbohydrate group) or 12.5% maltodextrin plus 15 g of glutamine (glutamine group) in two different moments 7 days apart. Magnetic ressonance was performed to measure the gastric residual volume (mL) 120 and 180 minutes after the last ingestion. RESULTS Gastric residual volume similar to basal condition was found after 2h and 3h of the intake of beverages. There was no difference in the mean ±SD GRV (mL) found at 120 minutes (carbohydrate group: 22.9±16.6 and glutamine group: 19.7±10.7) and at 180 minutes (carbohydrate group: 21.5±24.1 and glutamine group: 15.1±10.1) between the two drinks. CONCLUSIONS Gastric emptying is efficient, and occurs in up to two hours after the intake of a beverage containing either carbohydrate alone or carbohydrate associated with glutamine. The addition of glutamine to carbohydrate-enriched drink seems to be safe for the use up to 2h before an operation.
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Affiliation(s)
- Luigi R Brianez
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil
| | - Cervantes Caporossi
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil
| | - Yure W de Moura
- Instituto de Diagnósticos em Medicina, Hospital Santa Rosa, Cuiabá, MT, Brasil
| | - Lorena A Dias
- Instituto de Diagnósticos em Medicina, Hospital Santa Rosa, Cuiabá, MT, Brasil
| | - Regis V Leal
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil
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Caporossi C, Nogueira PLB, Marques JCC, Assis RMD, Aguilar-Nascimento JED. Validation of the gastroschisis experimental model and the influence of the mother's diet enriched with glutamine in the fetal morphology. Acta Cir Bras 2014; 29:158-65. [PMID: 24626727 DOI: 10.1590/s0102-86502014000300003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/19/2014] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To validate the gastroschisis experimental model in female rats and the effects on the glutamine fetal morphology during pregnancy. METHODS Twelve pregnant rats Wistar were separated in two groups: Group I (n = 6 rats, 71 fetuses) took glutamine and Group II (n = 6 rats, 75 fetuses) took isocaloric supplementation. At the 18th day of pregnancy, female rats were taken to hysterotomy and the fetuses which were selected for the act of gastroschisis were partially removed from the womb and by the laparotomy technique, the exclusion of the intestine was done. After that, fetuses were put in the womb cavity again and the rats' abdomen sutured. At the 21st day of pregnancy, date before delivery, by C-section ordinary animals and the ones with gastroschisis were removed and studied separately. The morphometrical parameters studied were the body weight (PC); the intestine weight (PI); the intestine length (CI) and its relations (PI/PC, PI/CI e PC-PI). RESULTS The intestine weight (PI) and the intestine length (CI) were different in fetuses with gastroschisis (p<0.05), however no difference between the groups regarding supplementation with glutamine. CONCLUSIONS The gastroschisis experimental model is valid and reproducible. The nutritional therapy with glutamine did not change the morphometrical parameters.
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Affiliation(s)
- Cervantes Caporossi
- Federal University of Mato Grosso, Department of Surgery, CuiabaMT, Brazil, PhD, Associate Professor, Division of Digestive Surgery, Department of Surgery, Federal University of Mato Grosso (UFMT), Cuiaba-MT, Brazil. Conception, design, intellectual and scientific content of the study
| | - Paulo Luiz Batista Nogueira
- UFMT, CuiabaMT, Brazil, Fellow Master degree, Postgraduate Program in Health Sciences, UFMT, Cuiaba-MT, Brazil. Acquisition and interpretation of data, manuscript writing
| | - José Carlos Costa Marques
- University of Cuiaba, School of Medicine, Department of Surgery, CuiabaMT, Brazil, Assistant Professor, Surgical Techniques Division, Department of Surgery, School of Medicine, University of Cuiaba (UNIC), Cuiaba-MT, Brazil. Acquisition of data, statistical analysis
| | - Rafael Moraes de Assis
- UNIC, Faculty of Veterinary Medicine, CuiabaMT, Brazil, Graduate student, Faculty of Veterinary Medicine, UNIC, Cuiaba-MT, Brazil. Surgical procedures, acquisition of data
| | - José Eduardo de Aguilar-Nascimento
- UFMT, Department of Surgery, CuiabaMT, Brazil, PhD, Full Professor, Division of Digestive Surgery, Department of Surgery, UFMT, Cuiaba-MT, Brazil. Critical revision
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Tavares de Araujo VM, Gomes PC, Caporossi C. Enteral nutrition in critical patients; should the administration be continuous or intermittent? NUTR HOSP 2014; 29:563-7. [PMID: 24559000 DOI: 10.3305/nh.2014.29.3.7169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
UNLABELLED Enteral nutrition therapy (ENT) is an essential part in the management of critically ill patients, having a significant impact on these patients' clinical results. It can be administered on a continuous or intermittent basis using an infusion pump. There is a discussion on which of these techniques has the best performance, involving a number of factors such as nausea, diarrhea, and particularly the relationship between diet volume and the ratio of programed calories to calories effectively supplied to the critical patients. OBJECTIVES To compare the forms of continuous or intermittent infusion of enteral nutrition, using as primary outcome the level of estimated caloric needs daily supplied. METHODS Observational prospective randomized clinical study carried out in an intensive care unit on 41 patients divided into two groups, of intermittent (ENT during 18 hours with a 6-hour nocturnal pause), or continuous (ENT during 24 hours continuously) administration. The secondary outcome variables measured in this study were bowel evacuation, distension, emesis, with the primary outcome variable being the relationship between infusion volume and the estimated-to-supplied ratio of caloric needs. The rejection index of the null hypothesis was established at 5% for all the tests. RESULTS Most of the patients received more than 60% infusion of enteral diet over the 5 days of study (p = 1.0), with no difference regarding the provision of caloric needs. No statistically significant difference between groups was found in the variables vomiting, abdominal distension or diarrhea. CONCLUSION The administration modalities of continuous or intermittent enteral nutrition are similar in which regards the comparison of the variables included in this study.
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Affiliation(s)
| | - Paulo César Gomes
- Coursing Master in Health Sciences at the Health Sciences Post-Graduation Program. Medical Sciences School (FCM)-UFMT-BR
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de Aguilar-Nascimento JE, Caporossi C, Metelo JS, Tanajura GH, Canevari-de-Oliveira M, da Cunha Costa R. Safe intake of an oral supplement containing carbohydrates and whey protein shortly before sedation to gastroscopy; a double blind, randomized trial. NUTR HOSP 2014; 29:681-6. [PMID: 24559015 DOI: 10.3305/nh.2014.29.3.7161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate the gastric emptying of an oral supplement containing carbohydrate plus whey protein drunk before sedation for gastroscopy. METHODS This is a randomized double-blind trial including adult patients (ages 18-65) with a chief complaint of epigastric burning and who were candidates to elective gastroscopy. After overnight fast subjects were randomized to drink 200 mL of an oral nutritional supplement containing maltodextrine in addition to whey protein 150 to 210 min before the gastroscopy (intervention group, n = 12) or to undergo the endoscopic procedure with no supplement (control group, n = 12). The residual gastric volume (RGV) suctioned and measured during the exam was the main endpoint of the study. RESULTS There were no complications during all exams. The median (range) fasting time was greater (P < 0.001) in control group (770 min, ranging from 660-917 min) than in the study group (175 min ranging from 150 to 210 min). The median (range) RGV was similar in between the two groups (control group: 25 (10-70) mL versus intervention group: 10 (0-100) mL; p = 0.32). CONCLUSION Gastric emptying 150-210 min after the ingestion of an oral supplement containing carbohydrate plus whey protein is similar to an overnight fasting condition. Although limited by the number of cases, the sedation for endoscopic procedures is safe with this fasting protocol.
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Semenoff TADV, Rosa Júnior A, Borges ÁH, Porto AN, Caporossi C, Semenoff Segundo A. Effect of chronic stress in newborn rats on the progression of ligature-induced-periodontitis in adulthood. Acta Cir Bras 2013; 28:652-6. [DOI: 10.1590/s0102-86502013000900005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/22/2013] [Indexed: 11/22/2022] Open
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Caporossi FS, Caporossi C, Borges Dock-Nascimento D, de Aguilar-Nascimento JE. Measurement of the thickness of the adductor pollicis muscle as a predictor of outcome in critically ill patients. NUTR HOSP 2012; 27:490-5. [PMID: 22732973 DOI: 10.1590/s0212-16112012000200021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 09/28/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Malnutrition is associated with complications and prolonged hospital stay in critically ill patients. We assessed whether the measurement of the thickness of the adductor pollicis muscle (TAPM), a new tool to assess malnutrition is a valuable prognostic indicator in critically ill patients. METHODS Open cohort study including 248 patients admitted for either medical or surgical intensive care treatment in a tertiary hospital. Two were discharged for having age below 18 years-old and therefore 246 subjects of both sexes completed the entire analysis. Subjective global assessment and APACHE II scores were used to score the patients. TAPM of both hands was measured at admission with a caliper and correlated with mortality, days of mechanical ventilation, and length of hospital stay (LOS). RESULTS There was a significant correlation (R = 0.84, p < 0.001) between TAPM of the right and the left hand. Severe malnourished patients showed TAPM of both the left (12.3 ± 5.5 mm) and right sides (12.9 ± 5.3 mm) significantly lower (p < 0.001) than either patients scored as nourished (right hand = 17.2 ± 5.4 mm and left hand = 15.8 ± 4.6 mm). Risk of death was approximately 8 times higher in patients with APACHEII score above 20 (OR: 8.6, 95% CI: 3.7-20.2; p < 0.001), and approximately 6 times higher in subjects with abnormal TAPM (OR: 6.3, 95% CI: 1.2-32.6; p = 0.02). However, TAPM did not correlate with length of stay and days of mechanical ventilation. CONCLUSION TAPM is a valuable tool to predict mortality in critically ill patients.
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Affiliation(s)
- F S Caporossi
- Health Sciences Postgraduate Course, Medical Sciences School, Federal University of Mato Grosso, Cuiaba, Brazil
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Dock-Nascimento DB, de Aguilar-Nascimento JE, Magalhaes Faria MS, Caporossi C, Slhessarenko N, Waitzberg DL. Evaluation of the Effects of a Preoperative 2-Hour Fast With Maltodextrine and Glutamine on Insulin Resistance, Acute-Phase Response, Nitrogen Balance, and Serum Glutathione After Laparoscopic Cholecystectomy. JPEN J Parenter Enteral Nutr 2012; 36:43-52. [DOI: 10.1177/0148607111422719] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | | | | | | | | | - Dan Linetzky Waitzberg
- LIM 35, Department of Gastroenterology, Medical School of University of São Paulo, São Paulo, Brazil
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Gouvêa Junior VT, Caporossi C, Salomão AB, Côrtes E, Munhoz MF, Nascimento JEAD. Effect of glutamine on the total antioxidant system of rats subjected to renal ischemia and reperfusion. Acta Cir Bras 2011; 26:445-50. [DOI: 10.1590/s0102-86502011000600007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 08/11/2011] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: To evaluate the protective effects of glutamine administered before renal ischemia-reperfusion on plasma antioxidant protection, and lung and renal tissue injury. METHODS: 33 rats underwent right nephrectomy. On the eighth postoperative day, animals were randomized into three groups (n=11): glutamine, control and sham. Each group of animals received, by gavage, a particular diet for 7 days. On day 14 following nephrectomy, the animals were subjected to left renal ischemia-reperfusion. After this, blood samples were collected and the animals were killed. At necropsy the kidney and lung were removed for histology. RESULTS: The levels of total antioxidant capacity were higher in the glutamine group and control group compared with the sham group. The levels of glutathione peroxidase in both the sham and glutamine groups were higher when compared with the control group (p<0.05). The level of superoxide dismutase in the sham group was clearly higher than that in the glutamine and control groups. Histological examination showed no differences between the three groups. CONCLUSION: Prior intake of glutamine improves total antioxidant capacity and increases glutathione peroxidase levels in rats subjected to renal ischemia-reperfusion.
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Bicudo-Salomão A, Meireles MB, Caporossi C, Crotti PLR, de Aguilar-Nascimento JE. Impact of the ACERTO project in the postoperative morbi-mortality in a university hospital. Rev Col Bras Cir 2011; 38:3-10. [PMID: 21537736 DOI: 10.1590/s0100-69912011000100002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Accepted: 02/25/2010] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the postoperative outcomes of patients in the Department of General Surgery, University Hospital Julio Muller, before and after implementation of the ACERTO multimodal protocol. METHODS We conducted a retrospective study from 5974 patients' charts. We compared two periods: from January 2002 to December 2004 (before implementation of the ACERTO protocol: AA period, n = 1987) and January 2005 to December 2008 (after implementation of the protocol: DA period, n = 3987). The variables studied were length of hospital stay, blood transfusions, surgical site infections (SSI), postoperative complications and deaths. RESULTS There was a decrease in one day in length of stay between the AA and DA period (median [range]: 4 [0-137] vs 3. [0-126] days and mode: 3 vs. 2 days, p < 0.001). During AA there was a relationship of 2.53 packs of blood products transfused per patient against 0.77 in the DA period (p <0.001). A downward trend in the number of cases of SSI was noticeable over the years (A =-153.08; AA: 7.51% vs. DA: 3.36% (p <0.001, RR = 2.23, 95 % CI:1.73-2.89). There was also a decreasing trend in operative complications (A =- 51.41, AA: 7.9% vs. DA: 6.14%, p = 0.02, RR = 1.29, 95% CI:1.03-1.60), reoperation (A =- 57.10; AA: 2.65%. vs DA: 1.19%, p <0.001, RR = 2, 22, 95% CI: 1.43 to 3.44) and deaths (A =- 62.07, 2.81 vs. 1%, 73%, p <0.01, RR = 1.63, 95% CI: 1.15 to 2.31). CONCLUSION The introduction of the ACERTO protocol improved the surgical results, expressed as a shorter hospital stay, blood transfusion, and reduction in cases of surgical site infection, postoperative complications and deaths.
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Affiliation(s)
- Alberto Bicudo-Salomão
- Department of Surgery, Faculty of Medical Sciences, Federal University of Mato Grosso (UFMT)-MT-BR
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Borges Dock-Nascimento D, Aguilar-Nascimento JED, Caporossi C, Sepulveda Magalhães Faria M, Bragagnolo R, Caporossi FS, Linetzky Waitzberg D. Safety of oral glutamine in the abbreviation of preoperative fasting: a double-blind, controlled, randomized clinical trial. NUTR HOSP 2011; 26:86-90. [PMID: 21519733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 09/22/2010] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION No study so far has tested a beverage containing glutamine 2 h before anesthesia in patients undergoing surgery. OBJECTIVES The aim of the study was to investigate: 1) the safety of the abbreviation of preoperative fasting to 2 h with a carbohydrate-L-glutamine-rich drink; and 2) the residual gastric volume (RGV) measured after the induction of anesthesia for laparoscopic cholecystectomies. METHODS Randomized controlled trial with 56 women (42 (17-65) years-old) submitted to elective laparoscopic cholecystectomy. Patients were randomized to receive either conventional preoperative fasting of 8 hours (fasted group, n = 12) or one of three different beverages drunk in the evening before surgery (400 mL) and 2 hours before the initiation of anesthesia (200 mL). The beverages were water (placebo group, n = 12), 12.5% (240 mOsm/L) maltodextrine (carbohydrate group, n = 12) or the latter in addition to 50 g (40 g in the evening drink and 10 g in the morning drink) of L-glutamine (glutamine group, n = 14). A 20 F nasogastric tube was inserted immediately after the induction of general anesthesia to aspirate and measure the RGV. RESULTS Fifty patients completed the study. None of the patients had either regurgitation during the induction of anesthesia or postoperative complications. The median (range) of RGV was 6 (0-80) mL. The RGV was similar (p = 0.29) between glutamine group (4.5 [0-15] mL), carbohydrate group (7.0 [0-80] mL), placebo group (8.5 [0-50] mL), and fasted group (5.0 [0-50] mL). CONCLUSION The abbreviation of preoperative fasting to 2 h with carbohydrate and L-glutamine is safe and does not increase the RGV during induction of anesthesia.
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Aguilar-Nascimento JED, Salomão AB, Caporossi C, Diniz BN. Clinical benefits after the implementation of a multimodal perioperative protocol in elderly patients. Arq Gastroenterol 2010; 47:178-83. [PMID: 20721464 DOI: 10.1590/s0004-28032010000200012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 01/21/2010] [Indexed: 12/20/2022]
Abstract
CONTEXT Multimodal protocol of perioperative care may enhance recovery after surgery. Based on evidence these new routines of perioperative care changed conventional prescriptions in surgery. OBJECTIVE To evaluate the results of a multimodal protocol (ACERTO protocol) in elderly patients. METHODS Non-randomized historical cohort study was performed at the surgical ward of a tertiary university hospital. One hundred seventeen patients aged 60 and older were submitted to elective abdominal operations under either conventional (n = 42; conventional group, January 2004-June 2005) or a fast-track perioperative protocol named ACERTO (n = 75; ACERTO group, July 2005-December 2007). Main endpoints were preoperative fasting time, postoperative day of re-feeding, volume of intravenous fluids, length of hospital stay and morbidity. RESULTS The implantation of the ACERTO protocol was followed by a decrease in both preoperative fasting (15 [8-20] vs 4 [2-20] hours, P<0.001) and postoperative day of refeeding (1st [1st-10th] vs 0 [0-5th] PO day; P<0.01), and intravenous fluids (10.7 [2.5-57.5] vs 2.5 [0.5-82] L, P<0.001). The changing of protocols reduced the mean length of hospital stay by 4 days (6[1-43] vs 2[1-97] days; P = 0.002) and surgical site infection rate by 85.7% (19%; 8/42 vs 2.7%; 2/75, P<0.001; relative risk = 1.20; 95% confidence interval = 1.03-1.39). Per-protocol analysis showed that hospital stay in major operations diminished only in patients who completed the protocol (P<0.01). CONCLUSION The implementation of multidisciplinary routines of the ACERTO protocol diminished both hospitalization and surgical site infection in elderly patients submitted to abdominal operations.
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de Aguilar-Nascimento JE, Bicudo-Salomão A, Caporossi C, Silva RDM, Cardoso EA, Santos TP, Diniz BN, Hartmann AA. Multimodal approach in colorrectal surgery without mechanical bowel cleansing. Rev Col Bras Cir 2009; 36:204-209. [PMID: 20076899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Accepted: 12/17/2008] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To evaluate the outcomes after the implementation of a multimodal protocol (ACERTO protocol) with patients undergoing colorectal operations. METHODS Fifty-three patients (37 M and 16 F; 57 [18-82] years old) submitted to various colorectal operations were prospectively studied in two different periods of time: from January 2004 through July 2005 (n=25, conventional group) and from August 2005 through June 2008 (n=28; ACERTO group). The patients received either the traditional perioperative management (including mechanical bowel cleansing) or a multidisciplinary protocol of perioperative care (without mechanical bowel cleansing) established by the ACERTO protocol. We looked at morbidity and mortality rates and length of hospital stay for comparisons between the groups. RESULTS Mortality was 3.8% (2 patients) without difference between groups. Preoperative fasting and postoperative feeding were shortened and intravenous fluids were diminished in patients operated under the ACERTO protocol (p<0.05). Postoperative morbidity (36% vs. 28.6%; p=0.56) and the incidence of anastomotic leak (12 vs. 10.7%; p=1.00) were similar. The number of complications per patient with any complication was lower in the ACERTO group (p=0.01). Changing protocols reduced the length of hospital stay by 4.5 days (12 [4-43] vs. 7.5 [3-47] days, p= 0.04). CONCLUSION The multidisciplinary routines of the ACERTO protocol are safe and enhanced recovery in colorectal surgery by reducing both hospitalization and the severity of postoperative morbidity.
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Aguilar-Nascimento JED, Bicudo-Salomão A, Caporossi C, Silva RDM, Cardoso EA, Santos TP, Diniz BN, Hartmann AA. Abordagem multimodal em cirurgia colorretal sem preparo mecânico de cólon. Rev Col Bras Cir 2009. [DOI: 10.1590/s0100-69912009000300005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJETIVO: Avaliar os resultados pós-operatórios de um protocolo multimodal de cuidados peri-operatórios sem preparo mecânico de cólon (protocolo ACERTO) em pacientes submetidos a operações colorretais. METODOS: Foram avaliados prospectivamente 53 pacientes (37M e 16F; 57 [18-82] anos) submetidos à diversas operações colorretais com pelo menos uma anastomose divididos em dois grupos. O primeiro grupo (n=25) foi operado entre Janeiro de 2004 e Julho de 2005 com protocolo convencional incluindo preparo mecânico de cólon. O segundo grupo (n=28) foi operado entre agosto de 2005 e junho de 2008, após a implantação do protocolo ACERTO e sem preparo de cólon. Comparou-se estatisticamente a incidência de complicações, a duração da hospitalização e a mortalidade em ambos os grupos. RESULTADOS: Dois (3,8%) pacientes faleceram no pós-operatório, um em cada grupo. Pacientes do grupo ACERTO tiveram jejum pré-operatório abreviado, receberam menos fluido intravenoso e re-alimentaram mais cedo que o grupo convencional (p<0.05). Não houve diferença na morbidade pós-operatória (36% vs. 28,6%; p=0,56) com incidência de fístula anastomótica semelhante (12 vs. 10,7%; p=1,00). O número de complicações por paciente foi menor no grupo ACERTO (p=0.01). O tempo de internação do grupo ACERTO, operado sem preparo de cólon foi abreviado em 4,5 dias (12 [4-43] dias vs 7,5 [3-47] dias, p = 0,04). CONCLUSÃO: As rotinas do protocolo ACERTO são seguras e melhoram resultados em cirurgia colorretal por diminuir gravidade de complicações e o tempo de internação.
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de Aguilar-Nascimento JE, Bicudo-Salomão A, Caporossi C, Silva RM, Cardoso EA, Santos TP. Enhancing surgical recovery in Central-West Brazil: The ACERTO protocol results. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.eclnm.2008.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Bicudo-Salomão A, Aguilar-Nascimento JED, Caporossi C. [Nutritional risk in surgery evaluated by body mass index adjusted or not to elderly patients]. Arq Gastroenterol 2007; 43:219-23. [PMID: 17160238 DOI: 10.1590/s0004-28032006000300012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 01/26/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Standard body mass index cut-off points for malnutrition are routinely used for adults independently of their age. The hypothesis of this study was that a cut-off point higher than the usual for the diagnosis of malnutrition might be more precise to access the nutritional risk of aged surgical patients. AIM To evaluate the morbimortality in aged surgical patients and its association with nutritional status assessed by body mass index using either the standard and a higher cut-off point for malnutrition. PATIENTS AND METHODS All patients admitted for operative procedures (n = 1,912) were allocated to either two groups: <65 years (n = 1,627) or >65 years old (n = 285). The body mass index was used to access the nutritional status. Two different cut-off points for malnutrition (18.5 or 24 kg/m(2)) were used in the group of older patients. Endpoints of the study were length of stay, morbidity and mortality. RESULTS Length of stay was higher in patients over 65 years (6 [1-75] days vs. 4 [1-137] days). Both postoperative complications (37/285; 13.0% vs. 109/1627; 6.7%; OR 2.1; IC95% 1.40-3.09) and deaths (15/285; 5.3% vs. 34/1627; 2.1%; OR 2.6; IC95% 1.40-4.84) were most common in the older group. Using a higher cut-off (24 kg/m(2)), the length of stay (8 [1-75] days vs. 4 [1-43] days), postoperative complications (28/152; 18.4% versus 9/133; 6.8%; OR 3,1; IC95% 1.41-6.86) and re-operations (16/152; 10.5% versus 3/133; 2.2%; OR 5.1; IC95% 1.45-17.91) were greater in malnourished patients. However these correlations were not statistically significant with the cut-off point for malnutrition in 18.5 kg/m(2). CONCLUSIONS Morbimortality is higher in surgical patients over 65 years old. In these, the cut-off point set in 24 kg/m(2) was most associated with the occurrence of postoperative complications, re-operations and length of stay.
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Aguilar-Nascimento JED, Bicudo-Salomão A, Caporossi C, Silva RDM, Cardoso EA, Santos TP. Volume de fluído intravenoso e alta hospitalar precoce em colecistectomia aberta. Rev Col Bras Cir 2007. [DOI: 10.1590/s0100-69912007000600005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJETIVO: Investigar se a adoção de um protocolo de restrição hídrica intravenosa em colecistectomia aberta diminui a permanência hospitalar. MÉTODO: Estudo prospectivo envolvendo pacientes submetidas a colecistectomia aberta após a adoção de um protocolo multimodal (projeto ACERTO). Pacientes com intercorrencias intra- ou pós-operatórias foram excluídas. Todas as pacientes receberam uma solução de carboidratos 2h antes da operação. Foram coletadas as seguintes variáveis: peso, altura, estado nutricional, volume total de fluidos intravenosos (VTFI) e volume prescrito em ml/kg de peso por dia. RESULTADOS: 64 pacientes (11 M e 53 F; idade mediana = 43 [18-65] anos) completaram o estudo. A re-alimentação pós-operatória ocorreu no mesmo dia da operação (62,5%) ou no dia seguinte (37,5%). Não foram registradas complicações infecciosas ou óbitos. O tempo mediano de internação pós-operatória foi de 1 (1-4) dia. Observou-se correlação entre o VTFI (r=0,44; p<0.001) e volume de fluídos / kg peso /dia (r=-0,29; p=0,03) e o tempo de internação pós-operatória. Alta no 1º PO foi possível em 73,3% dos casos quando a prescrição foi de até 20mL/Kg/dia e em 41,2% quando o volume prescrito foi maior (p<0.001; Odds Ratio=3,92; IC95% 1,36-11,32). CONCLUSÃO: A restrição de fluidos intravenosos em colecistectomia aberta determina alta mais precoce.
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de Aguilar-Nascimento JE, Caporossi C, Dock-Nascimento DB, de Arruda IS, Moreno K, Moreno W. Oral glutamine in addition to parenteral nutrition improves mortality and the healing of high-output intestinal fistulas. NUTR HOSP 2007; 22:672-676. [PMID: 18051993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE Anastomotic leakage is one of the most important causes of morbidity and mortality in gastrointestinal surgery. We investigated the effect of oral glutamine on the healing of high-output intestinal fistula. SETTING A tertiary Universitary Hospital of the University of Mato Grosso, Cuiaba, Brazil. PATIENTS AND METHODS 28 patients (25 males and 3 females; median age = 45 [18-71] years old) admitted with high output post-operative small bowel fistulas (median volume in 24 h: 850 [600-2,200] mL) during a 4 years period were retrospectively studied. INTERVENTIONS In the first two years 19 (67.9%) patients received only TPN as the initial nutritional support. In the last two years however, due to a change in the protocol for the nutritional support in cases of intestinal fistula 9 patients (32.1%) received oral glutamine (0.3 g/kg/day; 150 mL/day) in addition to TPN. Endpoints of the study were mortality, resolution of the fistula, and length of hospital stay (LOS). RESULTS The overall mortality was 46.4% (13 patients). Fistula closure was observed in all other 15 patients (53.6%) that survived. In the subset of survived patients LOS was similar in those who received or not received glutamine. The multivariate regression analysis showed that resolution of the fistula was 13 times greater in patients that received oral glutamine (OR = 13.2 (95% CI = 1.1-160.5); p = 0.04) and 15 times greater in non-malnourished patients (OR = 15.4 [95% CI = 1.1-215.5]; p = 0.04). CONCLUSIONS We conclude that oral glutamine accelerated the healing and diminished the mortality in this series of patients with post-operative high-output intestinal fistula receiving TPN.
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Affiliation(s)
- J E de Aguilar-Nascimento
- Department of Surgery, Julio Muller Universitary Hospital, University of Mato Grosso, Cuiabá, Brazil.
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Aguilar-Nascimento JED, Bicudo-Salomão A, Caporossi C, Silva RDM, Cardoso EA, Santos TP. Acerto pós-operatório: avaliação dos resultados da implantação de um protocolo multidisciplinar de cuidados peri-operatórios em cirurgia geral. Rev Col Bras Cir 2006. [DOI: 10.1590/s0100-69912006000300010] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJETIVO: O objetivo do presente estudo foi avaliar os resultados clínicos iniciais após a implementação do projeto Acerto Pós-operatório (ACERTO) em pacientes operados num serviço universitário de cirurgia geral. MÉTODO: 161 pacientes foram prospectivamente observados durante dois períodos: o primeiro, entre janeiro a junho de 2005 (n=77) formado por pacientes submetidos a condutas convencionais (período PRÉ-ACERTO) e o segundo, entre agosto a dezembro de 2005 (n=84), formado por pacientes submetidos a um novo protocolo de condutas peri-operatório estabelecidas pelo projeto ACERTO (período PÓS-ACERTO). A coleta de dados nos dois períodos ocorreu sem o conhecimento dos profissionais do serviço. As variáveis observadas foram: indicação de suporte nutricional pré-operatório, tempo de jejum pré e pós operatório, volume de hidratação, uso de sondas e drenos, tempo de internação e morbidade pós-operatória. RESULTADOS: Na fase pós-ACERTO, o percentual de pacientes desnutridos que receberam suporte nutricional foi trêsês vezes maior (78,6%; 11/14 vs. 23,5%; 4/17; p <0.01). Houve uma diminuição no tempo de jejum pré (16 [8-27] vs 5 [2-20] horas, p<0,01) e pós-operatório (3 [1-15] vs 1 [1-6] dias, p<0,01) e na hidratação venosa (8 [1-63,5] vs 4 [0,5-63] litros, p<0,001) na segunda fase do estudo. O conjunto de mudanças determinou uma redução de dois dias no tempo de internação (5 [2-46] vs 3 [1-64] dias, p<0,05) e de 60% na morbidade pós-operatória (18,2%;14/77 vs 7,1%;6/84, p=0,03; RR=2,55, IC95%1,03-6,29, p<0,05). CONCLUSÕES: A adoção das medidas multidisciplinares peri-operatórias como as do projeto ACERTO é factível dentro da nossa realidade e pode, melhorar a morbidade e diminuir o tempo de internação em cirurgia geral.
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Caporossi C, Cecconello I, Aguilar-Nascimento JE, Venço F, Gama-Rodrigues JJ. Hand-sewn and stapled esophageal anastomosis: experimental study in dogs. Acta Cir Bras 2004. [DOI: 10.1590/s0102-86502004000400002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: To compare experimentally, the healing of cervical oesophageal anastomoses performed either with stapler or 2-layer hand-sewn sutures. METHODS: Thirty six dogs were randomised to two groups: stapled anastomoses (n = 18); hand-sewn anastomoses (n = 18). Each group was divided into three subgroups, corresponding to the day of sacrifice (3rd, 7th and 14th postoperative day). Healing was assessed by: a) anatopathology b) anastomotic resistance to bursting pressure test; c) quantification of hidroxyproline RESULTS: Group 1 heal by second intention, group 2 showed a healing by first intention. Bursting pressure was similar between groups at day 3, though group 1 animals showed it significantly higher at day 7and day 14 compared with group 2. Statiscally, there were no interaction between the day of sacrifice and groups, as well as there was no difference among the dates of observation regarding the results of hidroxyproline CONCLUSIONS: a) mechanical suture is more resistant than hand-sewn; b) In stapler anastomoses, healing was as secondary union, whereas in hand-sewn anastomoses, healing was by first intention; c) no correlation was found in the results of bursting pressure and hidroxyproline quantification.
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de Aguilar-Nascimento JE, Caporossi C, Nascimento M. [Comparison between resection and primary anastomosis and staged resection in obstructing adenocarcinoma of the left colon]. Arq Gastroenterol 2002; 39:240-5. [PMID: 12870083 DOI: 10.1590/s0004-28032002000400006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The surgical option to deal with obstruction of the left side of the large bowel is still controversial. OBJECTIVE To report the experience of our group in the treatment of malignant left-sided colonic obstruction focusing on the immediate results using either one-stage resection and primary anastomoses or staged resection. PATIENTS/METHODS Twenty-three patients (median age = 52 (39-84) years; 10 males and 13 females) with potentially resectable obstructed adenocarcinomas of the left colon entered the study. The patients were submitted to different surgical procedure: 14 (60,9%) underwent one stage colonic resection (intra-operative lavage of colon (n = 10) or subtotal colectomy (n = 4); resection and primary anastomoses group) and 9 patients (39,1%) underwent staged resection (Hartmann's operation (n = 4) or loop colostomy (n = 5); staged resection group). RESULTS Two patients (8,7%) died. All were from the staged resection group. Four patients (44,4%) of staged resection group did not complete the treatment with the closing of the colostomy. The incidence of complications was 28,6% in resection and primary anastomoses group (4/14) and 66,7% in staged resection group (6/9). Hospital stay was 15 (9-45) in staged resection patients and 8 (6-20) in resection and primary anastomoses group. There was one case (7,1%) of anastomotic dehiscence in resection and primary anastomoses group and two cases (22,2%) in staged resection group. CONCLUSIONS The treatment of obstruction of left colon in one stage is safe and may be indicated for the management of the majority of cases.
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