medigraphic.com
ISSN 1995-9427 (Impreso)

2022, Número 1

<< Anterior Siguiente >>

Invest Medicoquir 2022; 14 (1)


Fallo intestinal agudo en el paciente crítico

Hernández FE, Quiles GL, Álvarez RA

Idioma: Español
Referencias bibliográficas: 40
Paginas:
Archivo PDF: 176.69 Kb.


RESUMEN

Los trastornos gastrointestinales son muy frecuentes en el paciente crítico. La disfunción gastrointestinal se asocia a anormalidades en la función motora intestinal, alteraciones en la microbiota, pérdida de la integridad de la barrera intestinal, traslocación bacteriana y alteración de la importante función inmunológica del intestino. Este daño local puede afectar a otros órganos, implicándose en el proceso etiológico de la enfermedad crítica y conduciendo a la aparición de un síndrome de respuesta inflamatoria sistémica y fracaso multiorgánico. Fue propósito de este trabajo describir las principales alteraciones intestinales en el paciente crítico y el tratamiento actualizado del mismo. Se realizó un estudio de revisión del tema «fallo intestinal en el paciente crítico». Se hizo la búsqueda en bases electrónicas (PubMed, OvidSP, Science Direct, MD Consult.) hasta septiembre del año 2019. A través de esta revisión fue posible describir las principales clasificaciones del fallo gastrointestinal agudo, las alteraciones funcionales y estructurales que sufre el intestino del paciente crítico, así como su tratamiento más eficaz. Se llegó a la conclusión que el fallo gastrointestinal agudo en el paciente crítico tiene un importante papel en la aparición de sepsis y fallo multiorgánico. Reconocerlo es fundamental, pues la enfermedad crítica altera la motilidad y la integridad del intestino.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Pironi L, Arends J, Baxter J and the Home Artificial Nutrition & Chronic Intestinal Failure and the Acute Intestinal Failure Special Interest Groups of ESPEN. ESPEN endorsed recommendations. Definition and classification intestinal of failure in adults. Clin Nut 2015; 34: 171-80.

  2. Shaffer J. Intestinal failure: definition and service development. Clin Nutr 2002;1 (21 S):144-5.

  3. Tarling MM, Toner CC, Withington PS, et al. A model of gastric emptying using paracetamol absorption in intensive care patients. Intensive Care Med 1997; 23:256–60.

  4. Ritz MA, Fraser R, Tam W, Dent J. Impacts and patterns of disturbed gastrointestinal function in critically ill patients. Am J Gastroenterol. 2000;95(11):3044-52. doi:.org/10.1111/j.1572-0241.2000.03176.x.

  5. Reintam A, Parm P, Kitus R, Starkopf J, Kern H. Gastrointestinal Failure score in critically ill patients: a prospective observational study. Critical Care. 2008;12(4):R90. doi:10.1186/cc6958.

  6. Montejo JC. Enteral nutrition-related gastrointestinal complications in critically ill patients: A multicenter study: The Nutritional and Metabolic Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units. Crit Care Med 1999; 27:1447-53. [http://dx.doi.org/10.1097/00003246-199908000-00006]

  7. Montejo JC, Grau T, Acosta J, et al. for the Nutritional and Metabolic Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units. Multicenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding with early gastric feeding in critically ill patients. Crit Care Med 2002; 30(4):796-800.

  8. Reintam A, Parm P, Kitus R, Kern H, Starkopf J. Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiol Scand 2009; 53:318–24.

  9. Reintam A, Parm P, Redlich U et al. Gastrointestinal failure in intensive care: a retrospective clinical study in three different intensive care units in Germany and Estonia. BMC Gastroenterology 2006; 6:19. DOI: 10.1186/1471-230X-6-19

  10. Reintam Blaser A, Poeze M, Malbrain MLNG, et al. Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study. Intensive Care Medicine. 2013;39(5):899-909. doi:10.1007/s00134-013-2831-1.

  11. Fleming CR, Remington M. Intestinal failure. In: Hill GL, editor. Nutrition and the surgical patient. Edinburgh: Churchill Livingstone; 1981. p. 219e-35.

  12. Reintam Blaser AR, Malbrain MLNG, Starkopf J, Fruhwald S, De Waele J, Braun J.P, et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM working group on abdominal problems. Intensive Care Med 2012; 38(3):384–94.

  13. Berger MM, Oddo M, Lavanchy J, Longchamp C, Delodder F, Schaller MD. Gastrointestinal failure score in critically ill patients. Critical Care 2008;12(6):436. doi:10.1186/cc7120.

  14. Ramiro-Puig E., Pérez-Cano F J, Castellote C, Franch A, Castell, M. El intestino: pieza clave del sistema inmunitario. Revista Española de Enfermedades Digestivas 2008;100(1): 29-34.

  15. Groschwitz KR, Hogan SP. Intestinal Barrier Function: Molecular Regulation and Disease Pathogenesis. The Journal of allergy and clinical immunology 2009;124(1):3-22. doi:10.1016/j.jaci.2009.05.038

  16. Salzman NH, Underwood MA, Bevins CL. Paneth cells, defensins, and the commensal microbiota: a hypothesis on intimate interplay at the intestinal mucosa. 2007;19(2):70-83.

  17. Borruel N. Interacciones bacterianas con el sistema inmunológico intestinal: Inmunomodulación. Gastroenterol Hepatol 2003;26(Supl 1):13-22.

  18. Ackland G, Grocott MP, Mytehen M. Understanding gastrointestinal perfusion in critical care: so near, and yet so far. Crit Care 2000; 4(5): 269–81. doi: 10.1186/cc709

  19. Nematy M, Brynes AE, Hornick PI, et al. Postprandial ghrelin suppression is exaggerated following major surgery; implications for nutritional recovery. Nutrition & Metabolism 2007; 4:20. doi:10.1186/1743-7 075-4-20.

  20. Taylor R W. Gut Motility Issues in Critical Illness. Crit Care Clin 32 (2016): 191–201. doi.org/10.1016/j.ccc.2015.11.003

  21. McDonald D, Ackermann G, Khailova L, et al. Extreme Dysbiosis of the Microbiome in Critical Illness. Green Tringe S, ed. mSphere 2016;1(4): e00199-16. doi:10.1128/mSphere.00199-16.

  22. Round JL, Mazmanian SK. The gut microbiota shapes intestinal immune responses during health and disease. Nat Rev Immunol 2009; 9:313–323.

  23. Brown E M, Sadarangani M & Finlay BB. The role of the immune system in governing host-microbe interactions in the intestine. Nature Immunology 3013; 14(7):660-7. doi:http://dx.doi.org/10.1038/ni.2611

  24. Puleo F, Arvanitakis M, Van Gossum A, Preiser JC. Gut failure in the ICU. Semin Respir Crit Care Med 2011;32(5):626-38. doi: 10.1055/s-0031-1287871.

  25. Shimizu, K, Ogura H, Hamasaki T et al. Altered gut flora are associated with septic complications and death in critically ill patients with systemic inflammatory response syndrome. Dig Dis Sci 2011; 56:1171–77. DOI 10.1007/ s10620-010-1418-8

  26. Shimizu K, Ogura H, Asahara et al. Gastrointestinal dysmotility is associated with altered gut flora and septic mortality in patients with severe systemic inflammatory response syndrome: a preliminary study. Neurogastroenterol Motil 2011;23 (4): 330–e157. doi: 10.1111/j.1365-2982.2010. 01653.x

  27. Mittal R, Coopersmith CM. Redefining the gut as the motor of critical illness. Trends Mol Med 2014 Apr; 20(4): 214–23. doi.org/10.1016/j.molmed.2013.08.004

  28. Meng M, Klingensmithb NJ and Coopersmithb CM. New insights into the gut as the driver of critical illness and Organ failure. Curr Opin Crit Care 2017 Apr;23(2):143-48. doi: 10.1097/MCC.0000000000000386. 28

  29. Klingensmith NJ, Coopersmith CM. The gut as the motor of multiple organ dysfunction in critical illness. Crit Care Clin 2016; 32:203–12.

  30. Deitch EA. Gut-origin sepsis: evolution of a concept. Surgeon 2012; 10:350-6. doi: 10.1016/j.surge.2012.03.003

  31. Senthil M, Brown M, Xu DZ, Lu Q, Feketeova E and Deitch EA. Gut-lymph hypothesis of systemic inflammatory response syndrome/multiple-organ dysfunction syndrome: validating studies in a porcine model. J Trauma 2006; 60:958-65.

  32. Landahl P, Ansari D, Andersson R. Severe Acute Pancreatitis: Gut Barrier Failure, Systemic Inflammatory Response, Acute Lung Injury, and the Role of the Mesenteric Lymph. Surg Infect (Larchmt) 2015;16(6):651-6.

  33. Deitch EA. Bacterial translocation or lymphatic drainage of toxic products from the gut: what is important in human beings. Surgery 2002; 131:241–4.

  34. Wischmeyer PE, McDonald D, Knight R. Role of the microbiome, probiotics, and “dysbiosis therapy” in critical illness. Current Opinion in Critical Care 2016;22(4):347-53. doi:10.1097/MCC.0000000000000321.

  35. De Jong PR, Gonzalez-Navajas JM, Jansen NJG. The digestive tract as the origin of systemic inflammation. Critical Care 2016; 20:279. DOI: 10.1186/s13054-016-1458-3 htps://ccforum.biomedcentral.com/articles/10.1186/s13054-016- 1458-3

  36. Mogensen KM, Robinson MK, Casey JD, Gunasekera NS, Moromizato T, Rawn JD, Christopher KB. Nutritional Status and Mortality in the Critically Ill. Crit Care Med 2015;43(12):2605-15. doi: 10.1097/CCM.0000000000001306.

  37. Hill LT. Gut dysfunction in the critically ill − mechanisms and clinical implications. S Afr J Crit Care 2013;29(2):11-5. doi:10.7196/SAJCC.148. http://www.sajcc.org.za/index.php/SAJCC/article/view/148/168

  38. Piton G, Manzon C, Cypriani B, Carbonnel F, Capellier G. Acute intestinal failure in critically ill patients: is plasma citrulline the right marker. Intensive Care Med 2011;37(6):911-7. doi: 10.1007/s00134-011-2172-x. https://www.ncbi.nlm.nih.gov/pubmed/21400011

  39. Crenn P, messing B, Cynober L. Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction. Clin Nutr. 2018: 27(3) 328–39.

  40. Picot D, Garin L, Trivin F, Kossovsky MP, Darmaun D, Thibault R. Plasma citrulline is a marker of absorptive small bowel length in patients with transient enterostomy and acute intestinal failure. Clin Nutr 2010;29(2):235-42. doi: 10.1016/j.clnu.2019.08.010.




2020     |     www.medigraphic.com