Terapia nutricional en el paciente crítico con COVID-19

Una revisión

  • Eduardo Moreira ASSE, Hospital Maciel, Centro de Tratamiento Intensivo. CASMER-FEPREMI. COMTA-FEPREMI. Unidad de Cuidados Intensivos
  • Estela Olano ASSE, Hospital Maciel, Centro de Tratamiento Intensivo. CASMU-IAMPP, 4Departamento de Medicina Intensiva y Unidad de Nutrición Especial
  • William Manzanares Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Centro de Tratamiento Intensivo. MUCAM, Unidad de Medicina Intensiva de Adultos
Palabras clave: CUIDADOS CRÍTICOS, CORONAVIRUS, INFECCIONES POR CORONAVIRUS, COVID-19, UNIDADES DE CUIDADOS INTENSIVOS, APOYO NUTRICIONAL

Resumen

Introducción: el distrés respiratorio agudo y la falla multiorgánica que determinan admisión en una unidad de cuidados intensivos (UCI) son una causa importante de morbimortalidad en pacientes con COVID-19. Los pacientes con peores resultados clínicos –incluido una menor sobrevida en UCI– son aquellos con múltiples comorbilidades, grados variables de inmunocompromiso, adultos mayores e individuos con desnutrición previa o secundaria a la enfermedad crítica. El impacto nutricional de la enfermedad crítica sobre el músculo estriado esquelético puede exacerbarse en algunos pacientes críticamente enfermos, los infectados por SARS-CoV-2 que requieren admisión a UCI.
Objetivo: proporcionar una orientación práctica de utilidad para los clínicos basados en la evidencia clínica actualizada y considerando ciertas características claves distintivas de la infección grave por SARS-CoV-2.
Método: se realizó una revisión exhaustiva de la literatura científica publicada hasta abril de 2020 en idiomas español e inglés.
Conclusiones: la pandemia de COVID-19 determina un desafío sin precedentes en la UCI, dado que no existen al momento medidas preventivas demostradas para evitar la evolución a la enfermedad crítica y los tratamientos curativos disponibles en esta fase de la enfermedad carecen de evidencia clínica de calidad que los sustenten. En este escenario complejo es probable que las medidas que contribuyan a potenciar el sistema inmunitario y las terapias de sostén en la UCI (incluido el soporte nutricional) sean armas sustanciales contra las infecciones graves por SARS-CoV-2; sin embargo, son necesarios más estudios en el entorno de la UCI para realizar recomendaciones específicas.

Citas

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Publicado
2020-12-01
Cómo citar
1.
Moreira E, Olano E, Manzanares W. Terapia nutricional en el paciente crítico con COVID-19. Rev. Méd. Urug. [Internet]. 1 de diciembre de 2020 [citado 28 de enero de 2021];36(4):382-9. Disponible en: https://revista.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/644
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