CROATIAN GUIDELINES FOR PERIOPERATIVE ENTERAL NUTRITION OF SURGICAL PATIENTS
Autori:
Marko Zelić, Darija Vranešić Bender, Dina Ljubas Kelečić, Željko Župan, Tedi Cicvarić, Branka Maldini, Iva Durut, Velimir Rahelić, Mate Škegro, Mate Majerović, Zdravko Perko, Alan Šustić, Tomislav Madžar, Borna Kovačić, Tihomir Kekez, Željko Krznarić
Sažetak
Nutritivni status bolesnika znatno utječe na ishod kirurškog liječenja, bilo da se radi o prekomjernoj težini i debljini ili o pothranjenosti uz gubitak mišićne mase. Neadekvatna nutritivna potpora u perioperativnom periodu ugrožava kirurške postupke čak i u bolesnika koji su adekvatno uhranjeni. U ovom smo radu osobitu pozornost posvetili pothranjenim bolesnicima kojih je oko 30% u populaciji hospitaliziranoj na kirurškim odjelima. Posebnu pozornost posvetili smo pitanju svrhovitosti preoperativnoga gladovanja i prihvaćanju novih spoznaja u ovom segmentu liječenja. Cilj ove radne skupine bio je sastaviti smjernice za perioperativnu nutritivnu potporu različitim modalitetima enteralne prehrane. U izradi smjernica sudjelovali su predstavnici društava Hrvatskoga liječničkog zbora: Hrvatskog društva za digestivnu kirurgiju, Hrvatskog društva za kliničku prehranu, Hrvatskoga kirurškog društva, Hrvatskog društva za endoskopsku kirurgiju, Hrvatskoga traumatološkog društva te Hrvatskog društva za anesteziologiju i reanimatologiju. Smjernice su oblikovane kao skup pitanja koja se pojavljuju svakodnevno u kliničkom radu tijekom pripreme bolesnika za kirurški zahvat te nakon samoga kirurškog liječenja, a odnose se na procjenu nutritivnog statusa, perioperativnu nutritivnu potporu, trajanje preoperativnog razdoblja gladovanja te odabir načina unosa hrane. Procjena nutritivnog statusa i primjena različitih modaliteta enteralne prehrane trebale bi ući u standardne postupnike dijagnostike i liječenja u hrvatskim bolnicama.
Summary
Nutritional status of patients significantly affects the outcome of surgical treatment, whether it’s about being obese or malnutrition with loss of muscle mass. Inadequate nutritional support in the perioperative period compromises surgical procedures even in patients who are adequately nourished. In this paper, particular attention was paid to malnourished patients, and their incidence in population hospitalized in surgical wards can be high up to 30%. Special emphasis was paid to the appropriateness of preoperative fasting and to the acceptance of new knowledge in this area of treatment. The aim of this working group was to make guidelines for perioperative nutritional support with different modalities of enteral nutrition. The development of these guidelines was attended by representatives of Croatian Medical Association: Croatian Society for Digestive Surgery, Croatian Society for Clinical Nutrition, Croatian Society of Surgery, Croatian Society for Endoscopic Surgery, Croatian Trauma Society and the Croatian Society of Anesthesiology and Intensive Care. The guidelines are designed as a set of questions that arise daily in clinical practice when preparing patients for surgery and after the surgical treatment, which relate to the assessment of nutritional status, perioperative nutritional support, duration of preoperative fasting period and the selection of food intake route. Assessment of nutritional status and the use of different modes of enteral nutrition should enter into standard protocols of diagnosis and treatment in the Croatian hospitals.
