Resumen
Objetivo: Identificar posibilidades para el manejo de pacientes con ostomías de alto gasto. Métodos: Revisión integrativa de la literatura realizada en las bases de datos PubMed, Cochrane Library y BVS entre junio y agosto de 2024, utilizando la estrategia de búsqueda “High Output Stoma” AND “Management”. Se incluyeron artículos en texto completo escritos en portugués, inglés o español entre 2014 y 2024. Resultados: se identificaron 104 estudios en las bases de datos. Luego de evaluar y perfeccionar el trabajo utilizando los criterios establecidos, se obtuvo un total de 13 estudios para su análisis. Se establecieron tres categorías temáticas para resumir la revisión: “uso de medicamentos”, “terapia nutricional” y “monitoreo nutricional”. Consideraciones finales: Los datos sugieren que el seguimiento nutricional temprano desde la hospitalización y especialmente después del alta, el uso de loperamida, la provisión de una dieta elemental/semielemental, la hidratación oral isotónica, el uso de espesantes, la creación de flujos institucionales y enfermería calificada La atención médica son posibilidades de manejo para pacientes con estoma de alto gasto.
Referencias
ADABA F, et al. Management of Intestinal Failure: the high-output enterostomy and enterocutaneous fistula. Clin Colon Rectal Surg. 2017;30(03):215-22.
AHMAD SJ, et al. Semi-elemental diet is effective in managing high output ileostomy; a case report. Gastroenterology and hepatology from bed to bench.2019;12(2), 169–173.
ARENAS VILLAFRANCA JJ, et al. Ostomías de alto débito: detección y abordaje. Nutr Hosp. 2014a;30(6):1391-1396.
ARENAS VILLAFRANCA JJ, et al. Protocol for the detection and nutritional management of high-output stomas. Nutr J. 2015b ;14(1).
BOULOUBASI Z, et al. Managing fluid balance and nutritional status in a short bowel syndrome patient awaiting intestinal transplant: a case report. Eur J Clin Nutr. 2024; 78:455-458.
CUYLE PJ, et al. Lanreotide in the prevention and management of high-output ileostomy after colorectal cancer surgery. J Drug Assess. 2018;7(1):28-33.
GALVÃO CM. Níveis de evidência. Acta Paul Enferm. 2006;19(2):5.
GOODEY A, COLMAN S. Safe management of ileostomates with high-output stomas. Br J Nurs. 2016;25(22):S4-S9.
HO CY, et al. Lower ileostomy output among postoperative colorectal cancer patients after supplemented with partially hydrolysed guar gum: outcome of a pilot study. Nutrition. 2022:111758.
INSTITUTO NACIONAL DE CÂNCER JOSÉ ALENCAR. Estimativa 2020: incidência de câncer no Brasil. Rio de Janeiro: Instituto Nacional de Câncer José Alencar Gomes da Silva; 2019. 120p. Disponível em: https://www.gov.br/inca/pt-br/assuntos/cancer/numeros/estimativa
KRISTENSEN K, QVIST N. The acute effect of loperamide on ileostomy output: a randomized, double-blinded, placebo-controlled, crossover study. Basic Amp Clin Pharmacol Amp Toxicol. 2017;121(6):493-8.
LANE A, et al. An elemental diet is effective in the management of diversion colitis. Gastroenterol Hepatol Bed Bench. 2021;14(1):81-84.
LEE YJ, et al. Nutritional management of a patient with a high-output stoma after extensive small bowel resection to treat crohn's disease. Clin Nutr Res. 2019;8(3):247.
MACKOWSKI A, et al. Successful management of chronic high-output ileostomy with high dose loperamide. Case Rep.2015;2015(apr22 1):bcr2015209411.
MCDONALD A. Orchestrating the management of patients with high-output stomas. Br J Nurs. 2014;23(12):645-9.
MENDES KDS, et al. Revisão integrativa: Método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm. 2008;17(4):758-64.
MOUNTFORD CG, et al. A practical approach to the management of high-output stoma. Frontline Gastroenterol. 2014;5(3):203-7.
PAGE MJ, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71):n71.
QUEIROZ ST, et al. Food consumption of macronutrients and nutritional status of people with ostomy. ESTIMA Braz J Enteros Ther. 2022.
RODRIGUES RP, et al. Fluxograma descritor do processo de trabalho: ferramenta para fortalecer a atenção primária à saúde. Saude Em Debate. 2019;43(spe6):109-16.
ROSTAMI K, AL DULAIMI D. Elemental diets role in treatment of high ileostomy output and other gastrointestinal disorders. Gastroenterol Hepatol Bed Bench. 2015;8(1):71-76.
SAHI N, et al. Loperamide. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2024.
SANTAMARÍA MM, et al. Impact of a nutrition consultation on the rate of high output stoma-related readmission: an ambispective cohort study. Sci Rep. 2021;11(1).
SANTOS CM, et al. The PICO strategy for the research question construction and evidence search. Rev Lat Am Enferm. 2007;15(3):508-11.
SCHOTT LL, et al. Characteristics, hospital length of stay, and readmissions among individuals undergoing abdominal ostomy surgery. J Wound Ostomy Amp Cont Nurs. 2022;49(6):529-39.
SILVA RA, et al. Cuidados de enfermagem ao paciente com estomia intestinal: uma revisão integrativa. Braz J Health Rev. 2020;3(4):10771-8.
URIBE AA, et al. Perioperative morbidity and complications in patients with an established ileostomy undergoing major abdominal surgery: a retrospective study. Front Surg. 2021;8.
WESTFALL KM, et al. Postoperative oral rehydration and regimented follow-up decrease readmissions for colorectal surgery patients with ileostomies. Dis Colon Amp Rectum. 2024; 67(2):313-21.
YASUKAWA Z, et al. Effect of repeated consumption of partially hydrolyzed guar gum on fecal characteristics and gut microbiota: a randomized, double-blind, placebo-controlled, and parallel-group clinical trial. Nutrients. 2019;11(9):2170.
ZACZEK Z, et al. Effect of thickening powder on gastrointestinal losses in patients with high-output end jejunostomy syndrome – preliminary results. Vivo. 2022;36(2):884-9.
