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Colegio de Medicina Interna de México.

2022, Número 3

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Med Int Mex 2022; 38 (3)


Respuesta a volumen en atención clínica: antecedentes históricos y utilidad terapéutica actual

García-Regalado J, Padilla-Sandoval EA

Idioma: Español
Referencias bibliográficas: 42
Paginas: 617-633
Archivo PDF: 279.68 Kb.


RESUMEN

La administración de soluciones intravenosas es una práctica realizada por casi todos los médicos. Actualmente, la única indicación de administrar soluciones intravenosas es provocar el aumento en el volumen latido del 10 al 15% posterior a su infusión. Este concepto es conocido como paciente respondedor a volumen. Sin embargo, este concepto aún es poco difundido, incluso entre médicos que laboran en áreas de urgencias, piso de medicina interna y terapia intensiva. Desafortunadamente, las principales indicaciones para infundir soluciones intravenosas se basan en parámetros que no pueden predecir dicha respuesta (por ejemplo: estado clínico, presión venosa central, déficit de base, uresis). Se ha demostrado que la administración excesiva de líquidos intravenosos, aun durante la fase inicial de la reanimación, puede no solo consumir recursos, sino incluso ser nociva para el paciente. Además, a pesar de existir herramientas que permiten de manera certera detener la reanimación hídrica previo a la aparición de su máxima complicación (edema agudo pulmonar) éstas son infravaloradas y poco utilizadas, ya sea por desconocimiento de su aplicación o por falta de confianza en ellas pese a la gran cantidad de evidencia que apoya su utilidad en la práctica clínica. Se realiza una revisión de la historia del uso de soluciones intravenosas, sus indicaciones y una aproximación para todos los médicos acerca del concepto paciente respondedor a volumen.


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