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1999, Número 4

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Rev Med Hosp Gen Mex 1999; 62 (4)


Traslocación bacteriana en el paciente grave

Carrillo ER, Núñez MFN

Idioma: Español
Referencias bibliográficas: 66
Paginas: 273-278
Archivo PDF: 53.87 Kb.


RESUMEN

La disfunción orgánica múltiple es una causa importante de mortalidad en la Unidad de Terapia Intensiva. La disfunción orgánica múltiple era considerada anteriormente secundaria a un proceso infeccioso no controlado; pero en la actualidad se ha comprobado que está en relación con un desequilibrio entre la respuesta proinflamatoria y antiinflamatoria sistémicas independientemente de la etiología inicial. La traslocación bacteriana es un fenómeno que se presenta en el paciente críticamente enfermo y que se caracteriza por el paso de bacterias y/o endotoxinas de la luz intestinal al torrente circulatorio o al sistema linfático. Lo anterior induce la producción de mediadores proinflamatorios, amplificando y perpetuando la respuesta inflamatoria sistémica. Estado de choque, fenómeno de isquemia-reperfusión, cirugía mayor de abdomen, quemaduras, pancreatitis, hipertensión intraabdominal, enfermedad inflamatoria intestinal, obstrucción intestinal, tumores colónicos, nutrición parenteral prolongada y el uso de octreótido y narcóticos son las principales causas de traslocación bacteriana. La reanimación adecuada del estado de choque con base en cristaloide, hidroxietilalmidón y dobutamina, la nutrición enteral temprana suplementada con glutamina y el uso de senósidos y lactulosa se han descrito como medidas que son útiles para disminuir la incidencia de la traslocación bacteriana y los efectos deletéreos de esta.


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