Publique en esta revista
Información de la revista
Vol. 35. Núm. S1.
Recomendaciones para el Soporte Nutricional del paciente crítico
Páginas 63-67 (Noviembre 2011)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 35. Núm. S1.
Recomendaciones para el Soporte Nutricional del paciente crítico
Páginas 63-67 (Noviembre 2011)
Acceso a texto completo
Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Paciente quemado crítico
Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): Criticallyburned patient
Visitas
...
A. García de Lorenzo y Mateosa,??
Autor para correspondencia
agdl@telefonica.net

Autor para correspondencia.
, C. Ortiz Leybab, S.M. Sánchez Sáncheza
a Hospital Universitario La Paz, Madrid, España
b Hospital Universitario Virgen del Rocío, Sevilla, España
Información del artículo
Resumen
Bibliografía
Descargar PDF
Estadísticas
Resumen

La respuesta que se objetiva tras una agresión térmica grave se caracteriza por hipermetabolismo (es el modelo de agresión más hipermetabólica que existe) e hipercatabolismo, con una elevada destrucción de la musculatura esquelética. Los trastornos metabólicos son más evidentes en las 2 primeras semanas tras la quemadura, aunque pueden prolongarse en relación directa con las complicaciones aparecidas. El soporte nutrometabólico forma parte indiscutible del tratamiento de estos pacientes y debe ser precoz, utilizando preferentemente la vía enteral y la nutrición parenteral complementaria. Es dificultoso el cálculo exacto de los requerimientos caloricoproteicos, aun empleando calorimetría indirecta, debido a las elevadas pérdidas cutáneas de proteínas y CO2. Cabe destacar la indicación de farmaconutrientes específicos, de dosis elevadas de micronutrientes y, en algunas situaciones, del empleo de medicaciones o fármacos con efectos anabólicos.

Palabras clave:
Quemado crítico
Shock hipovolémico
Nutrición parenteral complementaria
Nutrición hiperproteica
Abstract

The response to severe burns is characterized by hypermetabolism (the most hypermetabolic existing model of aggression) and hypercatabolism, with a high degree of destruction of the skeletal musculature. Metabolic disorders are most evident in the first two weeks after the burn, although they can be prolonged in direct relation to the complications that these patients develop. Nutritional-metabolic support is an essential part of the treatment of these patients enand should be started early, preferentially through the enteral route, with parenteral nutrition as complementary support. Exact calculation of calorie-protein requirements in these patients is difficult, even when indirect calorimetry is used, due to the high loss of proteins and CO2 through the skin. Specific pharmaconutrients are indicated, with a high dose of micronutrients. The use of drugs or medications with anabolic effects is also sometimes indicated.

Keywords:
Critically-ill burnt patient
Hypovolemic shock
Complementary parenteral nutrition
Hyperproteic nutrition
El Texto completo está disponible en PDF
Bibliografía
[1.]
P.B. Soeters, R.F. Grimble.
Dangers, and benefits of the cytokine mediated response to injury and infection.
Clin Nutr, 28 (2009), pp. 583-596
[2.]
C. Pereira, K. Murphy, D. Herndon.
Outcome measures in burn care. Is mortality dead?.
[3.]
K. Ipaktchi, S. Arbabi.
Advances in burn critical care.
Crit Care Med, 34 (2006), pp. S239-S244
[4.]
D.E. Carlson, W.G. Cioffi Jr., A.D. Mason Jr., W.F. McManus, B.A. Pruitt Jr..
Resting energy expenditure in patients with thermal injuries.
Surg Gynecol Obstet, 174 (1992), pp. 270-276
[5.]
S. Finfer, D.R. Chittock, S.Y. Su, D. Blair, D. Foster, V. Dhingra, NICE-SUGAR Study Investigators, et al.
Intensive versus conventional glucose control in critically ill patients.
N Engl J Med., 360 (2009), pp. 1283-1297
[6.]
G. Van den Berghe, A. Wilmer, G. Hermans, W. Meersseman, P.J. Wouters, I. Milants, et al.
Intensive insulin therapy in the medical ICU.
N Eng J Med, 354 (2006), pp. 449-461
[7.]
F. Jahoor, D.N. Herdnon, R.R. Wolfe.
Role of insulin and glucagon in the response of glucose and alanina kinetics in burn-injured patients.
J Clin Invest, 78 (1986), pp. 807-814
[8.]
D.R. Garrel, M. Razi, F. Larivière, N. Jobin, N. Naman, A. Emptoz-Bonneton, et al.
Improved clinical status and length of care with low-fat nutrition support in burn patients.
JPEN J Parenter Enteral Nutr, 19 (1995), pp. 482-491
[9.]
A. García-de-Lorenzo, R. Denia, P. Atlan, S. Martinez-Ratero, A. Le Brun, D. Evard, et al.
Parenteral nutrition providing a restricted amount of linoleic acid in severely burned patients: a randomised double-blind study of an olive oil-based lipid emulsion v. medium/long chain triacylglicerols.
Br J Nutr, 94 (2005), pp. 221-230
[10.]
R.G. Martindale, S.A. McClave, V.W. Vanek, M. McCarthy, P. Roberts, B. Taylor, et al.
Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition: Executive Summary.
Crit Care Med, 37 (2009), pp. 1757-1761
[11.]
P. Singer, M.M. Berger, G. Van den Berghe, G. Biolo, P. Calder, A. Forbes, ESPEN, et al.
ESPEN guidelines on parenteral nutrition: intensive care.
Clin Nutr, 28 (2009), pp. 387-400
[12.]
F.A. Moore, E.E. Moore.
The evolving rationale for early enteral nutrition based on paradigms of multiple organ failure: a personal journey.
Nutr Clin Pract, 24 (2009), pp. 297-304
[13.]
K.G. Kreyman, M.M. Berger, N.E. Deutz, M. Hiesmayr, P. Jolliet, G. Kazandjiev, ESPEN (European Society for Parenteral and Enteral Nutrition), et al.
ESPEN Guidelines on Enteral Nutrition: Intensive Care.
Clin Nutr, 25 (2006), pp. 210-223
[14.]
Y.P. Zhou, Z.M. Jiang, Y.H. Sun, X.R. Wan, E.L. Ma, D. Wilmore.
The effect of supplemental enteral glutamine on plasma levels, gut function, and outcome in severe burns: a randomized, doubleblind, controlled clinical trial.
JPEN J Parenter Enteral Nutr, 27 (2003), pp. 241-245
[15.]
M.M. Berger, M. Baines, W. Raffoul, M. Benathan, R.L. Chiolero, C. Reeves, et al.
Trace elements supplementation after major burns modulates antioxidant status and clinical course by way of increase tissue trace element concentrations.
Am J Clin Nutr, 85 (2007), pp. 1293-1300
[16.]
M.M. Berger.
Antioxidant micronutrients in major trauma and burns: evidence and practice.
Nutr Clin Pract, 21 (2006), pp. 438-449
[17.]
B.A. Latenser.
Critical care of the burn patient: the first 48 hours.
Crit Care Med, 37 (2009), pp. 2819-2826
[18.]
K. Prelack, M. Dylewski, R.L. Sheridan.
Practical guidelines for nutritional management of burn injury and recovery.
[19.]
M.M. Berger, W. Raffoul, A. Shenkin.
Practical guidelines for nutritional management of burn injury and recovery – a guideline based on expert opinion but not including RCTs.
[20.]
S.A. McClave, D.K. Heyland.
The physiologic response and associated clinical benefits from provision of early enteral nutrition.
Nutr Clin Pract, 24 (2009), pp. 305-315
[21.]
A.G. De Lorenzo, T. Grau, J.C. Montejo, C.O. Leyba, S.R. Santana.
SENPE-Baxter. III Working Meeting SENPE-Baxter: complementary parenteral nutrition in the critically ill patient.
Nutr Hosp, 23 (2008), pp. 203-205

SEMICYUC: Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias. SENPE: Sociedad Española de Nutrición Parenteral y Enteral.

Copyright © 2011. Sociedad Española de Medicina Intensiva, Critica y Unidades Coronarias (SEMICYUC) and Elsevier España, S.L.
Idiomas
Medicina Intensiva

Suscríbase a la newsletter

Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?