Comment optimiser la nutrition entérale du patient ventilé ?
Tóm tắt
La nutrition artificielle est une pierre angulaire de la prise en charge du patient traité par ventilation mécanique invasive. Les recommandations internationales préconisent d’instaurer la nutrition le plus précocement possible après l’admission et, en l’absence de contre-indication digestive formelle, de privilégier la voie entérale. Cependant, de nombreux facteurs concourent à entraver sa bonne administration. Parmi ceux-ci, l’intolérance digestive à la nutrition et la prévention de ses conséquences potentielles apparaissent régulièrement comme des obstacles fréquents. Cependant, la définition même et l’approche de l’intolérance digestive à la nutrition entérale doivent être reconsidérées. Les régurgitations et les vomissements ne semblent pas constituer un facteur source de complications significatives, notamment de pneumopathie acquise sous ventilation mécanique. Leur prévention et leur gestion ne doivent pas entraver à l’excès l’atteinte des objectifs nutritionnels. La surveillance du volume gastrique résiduel ne doit plus être réalisée en routine. En cas d’intolérance, l’administration d’un prokinétique gastrique doit précéder la diminution de la nutrition entérale qui ne doit être interrompue qu’en dernier recours, sauf signes de gravité ou orientant vers une cause organique qui nécessitera un traitement approprié et éventuellement de préférer la voie parentérale. L’utilisation d’un protocole prédéterminé, synthétisant les connaissances dans le domaine, adapté aux caractéristiques des patients accueillis dans l’unité et connu de tous les membres de l’équipe est un facteur favorisant l’atteinte des objectifs nutritionnels. Des travaux de recherche clinique en cours ou à venir devraient permettre de mieux étayer les futures recommandations dans le domaine de la nutrition artificielle du patient ventilé.
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