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Vol. 35. Núm. S1.
Recomendaciones para el Soporte Nutricional del paciente crítico
Páginas 77-80 (Noviembre 2011)
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Vol. 35. Núm. S1.
Recomendaciones para el Soporte Nutricional del paciente crítico
Páginas 77-80 (Noviembre 2011)
Acceso a texto completo
Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Paciente neurocrítico
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): Neurocritical patient
J. Acosta Escribanoa,��
Autor para correspondencia

Autor para correspondencia.
, I. Herrero Meseguerb, R. Conejero García-Quijadac
a Hospital General Universitario, Alicante, España
b Hospital Universitario de Bellvitge, Barcelona, España
c Hospital Universitario San Juan, Alicante, España
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El enfermo neurocrítico precisa un soporte nutricional especializado debido a su intenso catabolismo y a un prolongado período de ayuno. La vía de administración nutricional preferente es la gastrointestinal, particularmente la vía gástrica, siendo alternativas la vía transpilórica o la nutrición mixta enteral-parenteral en caso de no obtener un volumen nutricional eficaz superior al 60%.

El aporte calórico total oscila entre 20–30kcal/kg/día, según el período de evolución clínica en que se encuentre, con un aporte proteico superior al 20% de las calorías totales (hiperproteico). El inicio del aporte nutricional debe ser precoz.

La incidencia de complicaciones gastrointestinales es superior al enfermo crítico en general, siendo el aumento del residuo gástrico el más frecuente.

Debe establecerse un estrecho control de la glucemia, manteniéndose por debajo de 150mg/dl como en el resto de los enfermos críticos.

Palabras clave:
Paciente neurocrítico
Traumatismo craneoencefálico
Nutrición precoz

Neurocritical patients require specialized nutritional support due to their intense catabolism and prolonged fasting. The preferred route of nutrient administration is the gastrointestinal route, especially the gastric route. Alternatives are the transpyloric route or mixed enteralparenteral nutrition if an effective nutritional volume of more than 60% cannot be obtained.

Total calore intake ranges from 20–30kcal/kg/day, depending on the period of the clinical course, with protein intake higher than 20% of total calories (hyperproteic diet). Nutritional support should be initiated early.

The incidence of gastrointestinal complications is generally higher to other critically-ill patients, the most frequent complicat ion being an increase in gastric residual volume. As in other critically-ill patients, glycemia should be closely monitored and maintained below 150mg/dL.

Neurocritical patient
Traumatic brain injury
Early nutrition
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M.R. Bullock, R. Chesnut, J. Ghajar, D. Gordon, R. Hartl, D.W. Newell, et al.
Guidelines for the surgical management of traumatic brain injury.
Neurosurgery, 58 (2006),
J.G. Latorre, S.H. Chou, R.G. Nogueira, A.B. Singhal, B.S. Carter, C.S. Ogilvy, et al.
Effective glycemic control with aggressive hyperglycemia management is associated with improved outcome in aneurismal subarachnoid hemorrhage.
Stroke, 40 (2009), pp. 1644-1652
J.A. Frontera, A. Fernández, J. Claassen, M. Schmidt, H.C. Schumacher, K. Wartenberg, et al.
Hyperglycemia after SAH: predictors, associated complications, and impact on outcome.
N.Q. Nguyen, R.J. Fraser, L.K. Bryant, M. Chapman, R.H. Holloway.
Diminished functional association between proximal and distal gastric motility in critically ill patients.
Intensive Care Med, 34 (2008), pp. 1246-1255
N. Foley, S. Marshall, J. Pikul, K. Salter, R. Teasell.
Hypermetabolism following moderated to severe traumatic acute brain injury: a systematic rewiew.
J Neurotrauma, 25 (2008), pp. 1415-1431
W. Haider, F. Lackner, W. Schlick, H. Benzer, F. Gerstenbrand, K. Irsigler, et al.
Metabolic changes in the course of severe acute brain damage.
Eur J Intensive Care Med, 1 (1975), pp. 19-26
P. Perel, T. Yanagawa, F. Bunn, I. Roberts, R. Wentz, A. Pierro.
Nutritional support for head-injured patients.
Cochrane Database Syst Rev, 4 (2006),
S.J. Taylor, S.B. Fettes, C. Jewkes, R.J. Nelson.
Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury.
Crit Care Med, 27 (1999), pp. 2525-2531
N.Q. Nguyen, R.J. Fraser, L.K. Bryant, C. Burgstad, M.J. Chapman, M. Bellon, et al.
The impact of delaying enteral feeding on gastric emptying, plasma cholecystokinin, and peptide YY concentrations in critically ill patients.
Crit Care Med, 36 (2008), pp. 1469-1474
L. Kompan, G. Vidmar, A. Spindler-Vesel, J. Pecar.
Is early enteral nutrition a risk factor for gastric intolerance and pneumonia?.
Clin Nutr, 23 (2004), pp. 527-532
L. Kompan, B. Kremzar, E. Gadzijev, M. Prosek.
Effects of early enteral nutrition on intestinal permeability and the development of multiple organ failure after multiple injury.
Intensive Care Med, 25 (1999), pp. 157-161
G.S. Doig, P.T. Heighes, F. Simpson, E.A. Sweetman, A.R. Davies.
Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta analysis of randomised controlled trials.
Intensive Care Med, 35 (2009), pp. 2018-2027
R. Härtl, L.M. Gerber, Q. Ni, J. Ghajar.
Effect of early nutrition on deaths due to severe traumatic brain injury.
J Neurosurg, 109 (2008), pp. 50-56
G. Minard, K.A. Kudsk, S. Melton, J.H. Patton, E.A. Tolley.
Early versus delayed feeding with an immune-enhancing diet in patients with severe head injuries.
JPEN J Parenter Enteral Nutr, 24 (2000), pp. 145-149
I. Ng, J. Lim, H.B. Wong.
Effect of head posture on cerebral hemodynamics: its influence on intracranial pressure, cerebral perfusion pressure and cerebral oxygenation.
Neurosurgery, 54 (2004), pp. 593-597
J. Meixensberger, S. Baunach, J. Amschler, J. Dings, K. Roosen.
Influence of body position on tissue-pO2 cerebral perfusion pressure and intracranial pressure in patients with acute brain injury.
Neurol Res, 19 (1997), pp. 249-253
M.B. Drakulovic, A. Torres, T.T. Bauer, J.M. Nicolás, S. Nogué, M. Ferrer.
Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial.
Lancet, 354 (1999), pp. 1851-1858
G.V. Bochicchio, K. Bochicchio, S. Nehman, C. Casey, P. Andrews, T.M. Scalea.
Tolerance and efficacy of enteral nutrition in traumatic brain-injured patients induced into barbiturate coma.
JPEN J Parenter Enteral Nutr, 30 (2006), pp. 503-506
C. Faisy, E. Guerot, J.L. Dile, J. Labrousse, J.Y. Fagon.
Assessment of resting energy expenditure in mechanically ventilated patients.
Am J Clin Nutr, 78 (2003), pp. 241-249
E. Weekes, M. Elia.
Observations on the patterns of 24-hour energy expenditure changes in body composition and gastric emptying in head-injured patients receiving nasogastric tube feeding.
JPEN J Parenter Enteral Nutr, 20 (1996), pp. 31-37
M. McCall, K. Jeejeebhoy, P. Pencharz, R. Moulton.
Effect of neuromuscular blockade on energy expenditure in patients with severe head injury.
JPEN J Parenter Enteral Nutr, 27 (2003), pp. 27-35
S. Klein, J. Kinney, K. Jeejeebhoy, D. Alpers, M. Hellerstein, M. Murray, et al.
Nutrition support in clinical practice: review of published data and recommendations for future research directions. National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition.
JPEN J Parenter Enteral Nutr, 21 (1997), pp. 133-156
A. Bonet, T. Grau.
Glutamine, an almost essential amino acid in the critically ill patient.
Med Intensiva, 31 (2007), pp. 402-406
A.P. Houdijk, E.R. Rijnsburger, J. Jansen, R.I. Wesdorp, J.K. Weiss, M.A. Mc-Camish, et al.
Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma.
The Lancet, 352 (1998), pp. 772-776
F. Novak, D.K. Heyland, A. Avenell, J.W. Drover, X. Su.
Glutamine supplementation in serious illnes; a systematic review of the evidence.
Crit Car Med, 30 (2002), pp. 2022-2029
A. García-de-Lorenzo, A. Zarazaga, P.P. García Luna, F. González Huix, J. López Martínez, A. Miján.
Clinical evidence for enteral nutricional support wiht glutamine: a systematic review.
Nutrition, 19 (2003), pp. 805-811
A. Berg, B.M. Bellander, M. Wanecek, L. Gamrin, A. Elving, O. Rooyackers, et al.
Intravenous glutamine supplementation to head trauma patients leaves cerebral glutamate concentration unaffected.
Intensive Care Med, 32 (2006), pp. 1741-1746
A. Berg, B.M. Bellander, M. Wanecek, A. Norberg, U. Ungerstedt, O. Rooyackers, et al.
The pattern of amino acid exchange across the brain is unaffected by intravenous glutamine supplementation in head trauma patients.
Clin Nutr, 27 (2008), pp. 816-821
I.S. Falcão de Arruda, J.E. De Aguilar-Nascimento.
Benefits of early enteral nutrition with glutamine and probiotics in brain injury patients.
Clin Sci (Lond), 106 (2004), pp. 287-292
B. Young, L. Ott, E. Kasarskis, R. Rapp, K. Moles, R.J. Dempsey, et al.
Zinc supplementation is associated with improved neurologic recovery rate and visceral protein levels of patients with severe closed injury.
J Neurotrauma, 13 (1996), pp. 25-34
C.H. Kao, S.P. ChangLai, P.U. Chieng, T.C. Yen.
Gastric emptying in head-injured patients.
Am J Gastroenterol, 93 (1998), pp. 1108-1112
J.A. Acosta Escribano, R. Carrasco Moreno, M. Fernández Vivas, J.N. Navarro Polo, P. Más Serrano, J. Sánchez Payá, et al.
Gastric enteral intolerance in mechanically ventilated patients with traumatic cerebral lesión.
Nutr Hosp, 16 (2001), pp. 262-267
T.W. Grahm, D.B. Zadrozny, T. Harrington.
The benefits of early jejunal hyperalimentation in the head-injured patient.
Neurosurgery, 25 (1989), pp. 729-735
J.C. Montejo, T. Grau, J. Acosta, S. Ruiz-Santana, M. Planas, A. García-De-Lorenzo, et al.
Multicenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding with early gastric feeding in critically ill patient.
Crit Care Med, 30 (2002), pp. 796-800
D.A. Neumann, M.H. Delegge.
Gastric versus small-bowel tube feeding in the intensive care unit: a prospective comparison of efficacy.
Crit Care Med, 30 (2002), pp. 1436-1438
C.W. Hsu, S.F. Sun, S.L. Lin, S.P. Kang, K.A. Chu, C.H. Lin, et al.
Duodenal versus gastric feeding in medical intensive care unit patients: a prospective, randomized, clinical study.
Crit Care Med, 37 (2009), pp. 1866-1872
J. Acosta-Escribano, M. Fernández-Vivas, T. Grau Carmona, J. Caturla-Such, M. García-Martínez, A. Menéndez-Mainer, et al.
Gastric versus transpyloric feeding in severe traumatic brain injury: a prospective, randomized trial.
Intensive Care Med, 36 (2010), pp. 1532-1539
F. Bilotta, A. Spinelli, F. Giovannini, A. Doronzio, R. Delfini, G. Rosa.
The effect of intensive insulin therapy on infection rate, vasospasm, neurologic outcome, and mortality in neurointensive care unit after intracranial aneurysm clipping in patients with acute subarachnoid hemorrhage: a randomized prospective pilot trial.
J Neurosurg Anesthesiol, 19 (2007), pp. 156-160
P. Vespa, R. Boonyaputthikul, D.L. McArthur, C. Miller, M. Etchepare, M. Bergsneider, et al.
Intensive insulin therapy reduces microdialysis glucose values without altering glucose utilization or improving the lactate/pyruvate ratio after traumatic brain injury.
A. Rovlias, S. Kotsou.
The influence of hyperglycemia on neurological outcome in patients with severe head injury.
Neurosurgery, 46 (2000), pp. 335-342
E. Jeremitsky, L.A. Omert, C.M. Dunham, J. Wiberger, A. Rodríguez.
The impact of hyperglycemia on patients with severe brain injury.
J Trauma, 58 (2005), pp. 47-50
D.M. Green, K.H. O’Phelan, S.L. Bassin, C.W. Chang, T.S. Stern, S.M. Asai.
Intensive versus conventional insulin therapy in critically ill neurologic patients.
Neurocrit Care, 13 (2010), pp. 299-306

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.
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