Historia de la nutrición parenteral
DOI:
https://doi.org/10.56050/01205498.2228Resumen
La nutrición parenteral (NP) es una técnica de nutrición inventada en la década de 1960, que ha salvado la vida de pacientes que presentaban formas graves de insuficiencia o falla gastrointestinal. El desarrollo de esta técnica requirió creatividad, multidisciplinariedad y tecnología. La NP inicialmente se denominó hiperalimentación, ya que sus primeros objetivos eran proporcionar grandes cantidades de energía por encima de las necesidades fisiológicas en un intento de combatir la desnutrición, una estrategia que resultó ser deletérea. La medida del gasto energético con calorimetría indirecta confirmó necesidades menores y está reemplazando progresivamente el uso de ecuaciones predictivas que resultaron en sobrealimentación y múltiples complicaciones.
Los componentes de la NP se desarrollaron paso a paso, siendo los aminoácidos los primeros en progresar en la década de 1960, pero permanecen incompletos en ausencia de algunos aminoácidos condicionalmente esenciales como la glutamina. Las emulsiones de lípidos intravenosos (ELI) estuvieron disponibles por primera vez en Europa como emulsiones puras derivadas de la soya n-6: los triglicéridos de cadena media (MCT) aparecieron primero, seguidos por los ácidos grasos monoinsaturados n-9 y, a partir de la década de 1990, las emulsiones derivadas del aceite de pescado. Estos últimos han mejorado significativamente los resultados y reducido el riesgo de infecciones y complicaciones hepáticas. Si bien la glucosa concentrada
estuvo disponible desde el principio, el impacto nocivo de las dosis que excedieron su capacidad oxidante máxima resultó en hiperglucemia nociva en pacientes enfermos resistentes a la insulina. Este problema se abordó desde 2001 con infusión continua de insulina. Las indicaciones para la estrategia de PN han sido definidas con precisión.
Biografía del autor/a
Mette M. Berger, University of Lausanne
Prof. Hon. University of Lausanne, Lausanne Switzerland
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