Sobre el lugar y la efectividad de los ácidos grasos w3 en la Nutrición artificial

Alfredo Matos Adames

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Las propiedades farmacológicas de los ácidos grasos poliinsaturados de la serie w3 (AGPI-3) han sido explotadas en diversas aplicaciones de la Nutrición artificial. Los AGPI-3 se han incorporado en preparaciones enterales empleadas como adyuvantes de la citorreducción tumoral y la contención de la inflamación, la sepsis y la injuria. Los AGPI-3 también se han utilizado como soluciones parenterales en situaciones clínico-quirúrgicas metabólicamente complejas como el trauma, la quemadura, y la injuria pulmonar aguda. La efectividad de los AGPI-3 como agentes farmacológicos vehiculados en una matriz nutrimental se ha establecido mediante modelos in vitro, tras experimentación animal, y gracias a estudios en voluntarios sanos. La efectividad de los AGPI-3 también se ha medido del acortamiento de la estadía hospitalaria, la reducción de la duración de la ventilación mecánica, y la disminución del uso de antibióticos; en los pacientes críticamente enfermos, o aquellos que evolucionan después de una cirugía de elevado impacto nutricional. Los AGPI-3 pueden aminorar la respuesta inflamatoria sistémica desatada tras la agresión, y proteger al endotelio y el alvéolo del daño pro-inflamatorio y pro-oxidante, asegurando así una mejor perfusión tisular por un lado, y una mejor ventilación e intercambio de gases, por el otro. La administración de las soluciones parenterales de AGPI-3 (como especies químicas únicas o combinadas con otras familias de AGPI) es segura, y se asocia a una baja tasa de complicaciones. La efectividad de las preparaciones enterales que incorporan AGPI-3 depende de las características del régimen de infusión, la vía de administración que se emplee, la dosis a instilar, la constancia del medio interno, y la tolerancia del enfermo. Lo anteriormente dicho no presupone que los AGPI-3 sean universalmente efectivos. Los grupos básicos de trabajo deben elaborar pautas locales que sean trazables hasta las recomendaciones de los cuerpos de expertos y las sociedades profesionales para la elección del mejor momento del uso de un producto contentivo de AGPI-3, la definición de los objetivos terapéuticos a alcanzar con el mismo, las condiciones para el uso seguro, el seguimiento regular, y la verificación del impacto logrado.

Palabras clave

Lípidos; Nutrición artificial; Nutrición enteral; Nutrición parenteral; Ácidos grasos poli-insaturados w3

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