Ibarra-Estrada MA, Briseño-Ramírez J, Chiquete E, Ruiz-Sandoval JL

Idioma: Español
Referencias bibliográficas: 47
Paginas: 289-295
Archivo PDF: 49.07 Kb.

RESUMEN

En años recientes se ha reconocido con mayor frecuencia a la enfermedad neuromuscular adquirida del paciente en estado crítico, tanto en la forma de miopatía aguda, como de polineuropatía y de bloqueo persistente por relajantes neuromusculares. La polineuropatía y la miopatía del enfermo en estado crítico (PEC y MEC, respectivamente) se caracterizan por la presencia de debilidad manifestada como una cuadriparesia usualmente fláccida y simétrica, así como por la reducción y/o ausencia de reflejos tendinosos profundos. El involucramiento de nervios frénicos, músculos intercostales y respiratorios accesorios, así como la atrofia y disfunción contráctil del diafragma han sido descritos como causa de retraso en el retiro del soporte ventilatorio mecánico en estos pacientes. Aunque los estudios electrofisiológicos de rutina algunas veces no pueden discriminar entre la MEC o PEC, sobre todo porque muy frecuentemente coexisten ambas condiciones en el mismo paciente, son útiles para descartar otras causas de debilidadneuromuscular, pudiendo incluso utilizarse como referentes antes del retiro de la sedación. A pesar de que varios ensayos clínicos proponen como opciones de tratamiento el aporte nutricional con diversos suplementos y antioxidantes, así como la aplicación de inmunoglobulina intravenosa y proteína C activada, ninguno ha demostrado su utilidad. El único tratamiento hasta la fecha es preventivo, haciendo énfasis en reducir o descontinuar tan pronto sea posible los glucocorticoides y bloqueadores neuromusculares, obtener un control estricto de la glucemia con insulina, manejo agresivo de los procesos sépticos, implementación temprana de pruebas de respiración espontánea en pacientes con ventilación mecánica, anticipación a complicaciones médicas adicionales y la rehabilitación temprana.

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