Sobre el apoyo nutricional del paciente quemado

Alejandro Torres Amaro, Rafael Jiménez García

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Resumen

La quemadura repercute en prácticamente todos los dominios del estado de salud al desencadenar una dramática respuesta a la agresión que puede conducir a la sepsis, la falla múltiple de órganos y la muerte. Los supervivientes pueden exhibir secuelas que requerirán tratamientos quirúrgicos especializados dilatados en el tiempo. El apoyo nutricional es indispensable en todo momento para asegurar la mejor respuesta del huésped a la agresión y la reducción del riesgo de complicaciones junto al acortamiento de la estadía hospitalaria; a la vez que el arraigo de los injertos de piel y el sostén de la reparación y cicatrización tisulares. Debe reconocerse el hipermetabolismo que acompaña a la quemadura. Se requiere evaluar continuamente la capacidad del huésped de sostener el estado nutricional del uso de la vía oral y de utilizar adecuadamente los nutrientes aportados. El apoyo nutricional debe iniciarse tan pronto culmine la resucitación y la reanimación del quemado, y se asegure la estabilidad hemodinámica y la perfusión tisular. Si bien la vía oral debería preferirse para alimentar al paciente, la colocación de sondas nasoenterales podría ser necesaria en muchos de ellos para evitar baches en la provisión de nutrientes. La prescripción dietética podría complementarse con nutrientes enterales de alta densidad energética en aras de satisfacer los elevados requerimientos nutricionales constatados en el quemado. Se han descrito dietas de inmunomodulación que incorporan antioxidantes, glutamina y nucleótidos para uso en el
apoyo nutricional del quemado, pero los resultados obtenidos con su administración han sido mixtos. La implementación de esquemas de nutrición parenteral obligaría a discutir sobre las mejores (posibles) vías de acceso en un enfermo que puede mostrar lesiones corporales extensas. Las complicaciones que se originen de la implementación y conducción de las terapias nutricionales deben ser identificadas tempranamente, corregidas adecuadamente, y prevenidas en última instancia. La complejidad clínico-metabólica de la quemadura justifica el diseño,
implementación y gestión de un programa de intervención alimentaria, nutrimental y metabólica
en el Servicio de Quemados que provea a los grupos básicos con pautas y normas de actuación en
cada momento de la evolución del paciente.

Palabras clave

Quemadura; Apoyo nutricional; Nutrición artificial; Metabolismo; Nutrición enteral; Nutrición parenteral

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