BRIEF NOTE

Refeeding Syndrome, Sarcopenia, and the Neurocritical Patient

Síndrome de Realimentação, Sarcopenia e o Paciente Neurocrítico

  • Leonardo Christiaan Welling 1    Leonardo Christiaan Welling 1
  • Nícollas Nunes Rabelo 2,3,4    Nícollas Nunes Rabelo 2,3,4
  • Mateus Gonçalves de Sena Barbosa 4    Mateus Gonçalves de Sena Barbosa 4
  • Renan Salomão Rodrigues 2,3
  • Eberval Gadelha Figueiredo 2,3    Eberval Gadelha Figueiredo 2,3
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Resumo

O cuidado neurocrítico visa minimizar danos neurológicos secundários após eventos neurológicos agudos, exigindo suporte nutricional precoce em condições como trauma craniano grave. Esse estado desencadeia hipercatabolismo, hipermetabolismo e aumento do gasto energético em até 200%. A síndrome de realimentação (SR), uma preocupação crítica em pacientes desnutridos, leva a distúrbios metabólicos e disfunção de múltiplos órgãos. A hipofosfatemia, uma característica central, acompanha irregularidades eletrolíticas. Embora o prognóstico clínico associado ao suporte nutricional careça de padronização, estudos sugerem resultados aprimorados com distribuição adequada de calorias e proteínas. As taxas de incidência de SR em pacientes neurocríticos permanecem incertas, mas sua ocorrência está associada a permanências prolongadas em UTI e maior mortalidade. A síndrome da fragilidade, caracterizada pelo declínio fisiológico, especialmente no sistema musculoesquelético, é cada vez mais reconhecida na gerontologia. Medidas musculares, como a atrofia do músculo masseter, correlacionam-se com resultados piores em pacientes com lesão cerebral traumática. Apesar de mais de 50 anos de reconhecimento, a síndrome de realimentação persiste com alta prevalência e mortalidade, e mais pesquisas são necessárias, especialmente em relação a possíveis fatores de risco, como a atrofia do músculo masseter em pacientes neurocríticos.

Palavras-chave

Síndrome de realimentação; Sarcopenia; Pacientes; Neurocrítico

Abstract

Neurocritical care aims to minimize secondary neurological damage post-acute neurological events, necessitating early nutritional support in conditions like severe head trauma. This state triggers hypermetabolism, hypercatabolism, and increased energy expenditure by up to 200%. Refeeding syndrome (RFS), a critical concern in malnourished patients, leads to metabolic disturbances and multiple organ dysfunction. Hypophosphatemia, a pivotal feature, accompanies electrolyte irregularities. While the clinical prognosis associated with nutritional support lacks standardization, studies suggest improved outcomes with adequate calorie and protein distribution. Incidence rates of RFS in neurocritical patients remain unclear, but its occurrence is associated with prolonged ICU stays and higher mortality. Frailty syndrome, characterized by physiological decline, particularly in the musculoskeletal system, is increasingly recognized in gerontology. Muscle measurements, such as masseter muscle atrophy, correlate with worse outcomes in traumatic brain injury patients. Despite over 50 years of recognition, refeeding syndrome persists with high prevalence and mortality, and further research is needed, especially regarding potential risk factors such as masseter muscle atrophy in neurocritical patients.

Keywords

Refeeding syndrome; Sarcopenia; Patients; Neurocritical

References

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1Department of Neurosurgery, Universidade Estadual de Ponta Grossa, Paraná, Brazil.

2Division of Neurosurgery, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo SP, Brazil.

3Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo SP, Brazil.

4Department of Neurosurgery, Faculdade de Medicina Atenas, Passos - MG, Brazil.

 

Received Jan 23, 2024

Accepted Apr 2, 2024

JBNC  Brazilian Journal of Neurosurgery

JBNC
  •   ISSN (print version): 0103-5118
  •   e-ISSN (online version): 2446-6786
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