Martinuzzi A

Language: Spanish
References: 0
Page: 322-337
PDF size: 270.17 Kb.

ABSTRACT

Sepsis is a clinical-metabolic situation carrying an elevated mortality risk for the critically ill patient because it might end up with multiple organ failure (MOF), thus forcing to new, intensive and aggressive therapeutical actions in order to preserve the patient´s life. It is accepted today nutritional support to become integrated into the general treatment of a patient being diagnosed with sepsis. However, intimacy of nutritional support is still surrounded by contradictions and controversies. Nutritional support should be initiated only if hemodynamic and internal milieu’s stability and splanchnic perfusion are secured in the patient. Quantities of nutrients to be provided (energy included) should be adjusted for the capacity of the patient to use them effectively. Nutrients able to influence upon the activity of the immune system have been identified, such as glutamine, los nucleotides, oligoelements and 3 fatty acids. Enteral route should be preferred over the parenteral one for providing the prescribed nutrients, as complement of parenteral nutrition (PN) schemes, and as a strategy for preventing progression of MOF. Immunomodulation diets (IMD) incorporating glutamine and antioxidants might be beneficial for patient´s survival, weaning from ventilator, and shortening of hospital length of stay. PN should be considered when enteral route does not suffice for fulfilling patient´s nutrient requirements. Preparations of glutamine dipeptides and lipid emulsions incorporating fish oil have been formulated intending to allow a better treatment of sepsis, but accumulated results have been contradictory, and even counterproductive. Parenteral supplementation with selenium in sepsis has been discussed, but benefits of the provision of supraphysiological quantities of this oligoelement have not been proved. Nutritional support in sepsis should evolve from merely fulfilling the patient´s nutritional requirements and providing nutrients in an effective way, to also modify host´s response to sepsis and the activity of the immune system and preventing complications of sepsis.