RESUMO
A polytraumatized patient is defined as one who has multiple lesions involving different organs and systems, which are usually serious and lead to life-threatening respiratory or circulatory dysfunction. Traumatic stress in the polytraumatized patient results in many metabolic changes that are evident from the first days, but usually persist for weeks, requiring adequate nutritional support as they influence outcomes. Nutritional treatment should be a priority in the comprehensive treatment of polytraumatized patients since it attenuates the metabolic response to trauma and prevents the deterioration of body reserves. It should be noted that some patients present previous nutritional risk. Nutritional intervention should be considered at the same level as any other therapy that supports organic functions, especially in patients in the intensive care unit. Nutritional intervention in polytraumatized patients is a pillar of treatment that has multiple benefits and can improve prognosis. All efforts must be aimed at the early detection of malnourished patients at nutritional risk and providing timely therapies that improve clinical outcomes.
El paciente politraumatizado se define como aquel que tiene múltiples lesiones que involucran diferentes órganos y sistemas, suelen ser graves y conllevan una disfunción respiratoria o circulatoria que pone en riesgo la vida. El estrés traumático en el paciente politraumatizado da lugar a muchos cambios metabólicos que son evidentes desde los primeros días, pero suelen persistir durante semanas y exigen un adecuado soporte nutricional, ya que influyen en los desenlaces. El tratamiento nutricional debe ser una prioridad en el tratamiento integral de los pacientes politraumatizados, porque atenúa la respuesta metabólica al trauma y evita el deterioro de las reservas corporales (cabe mencionar que algunos pacientes presentan riesgo nutricional previo). La intervención nutricional debe considerarse al mismo nivel que cualquier otra terapia que apoye las funciones orgánicas, sobre todo en pacientes en la unidad de terapia intensiva. La intervención nutricional en pacientes politraumatizados es un pilar en el tratamiento que tiene múltiples beneficios y puede mejorar el pronóstico. Todo esfuerzo debe ir encaminado a la detección temprana de pacientes desnutridos o en riesgo nutricional, y proporcionar de manera oportuna terapias que mejores los desenlaces clínicos.
Assuntos
Unidades de Terapia Intensiva , Humanos , Prognóstico , Estudos RetrospectivosRESUMO
The intestine plays a fundamental role as a regulator of the mucosal immune response, mostly through the production and secretion of secretory Immunoglobulin A (sIgA) by the gut-associated lymphoid tissue (GALT). Enteral stimulation, a balance between the commensal microbiota and pathogenic microorganisms, in addition to an adequate nutritional status is required for the optimal immune function of the intestine. Fasting subjects or those supported only with parenteral nutrition, show a progressive anatomical and physiological deterioration of the GALT, triggering a series of alterations resulting in a decrease in the intestinal immune response, modification in the type of microbiota, and changes that lead to or aggravate malnutrition. Patients with malnutrition present an increase in the rate of nosocomial infections, hospital length of stay, and mortality. An adequate nutritional assessment at hospital admission and avoiding long periods of fasting are paramount to prevent these unfavorable outcomes. Herein, we present a mini-state of the art review on the role and importance of enteral stimulation by GALT-mediated immune response.
