Fisioterapia, ventilación mecánica y nutrición en paciente obeso crítico. Una revisión literaria
DOI:
https://doi.org/10.31790/inspilip.v8i26.676Palabras clave:
Obeso, Cuidados críticos, Nutrición, Fisioterapia, Ventilación mecánicaResumen
Introducción: Múltiples factores contribuyen a los resultados adversos y la mortalidad de la obesidad en UCI. La fisioterapia es un complemento importante en el tratamiento de la obesidad. La ventilación mecánica no invasiva se considera la terapia de primera línea en pacientes obesos, con insuficiencia respiratoria aguda posoperatoria. Objetivos: Realizar una revisión sobre la utilidad de la fisioterapia respiratoria, ventilación mecánica y nutrición en el obeso crítico. Objetivos específicos: Analizar la fisioterapia respiratoria en el paciente obeso y determinar los efectos de la ventilación mecánica en el obeso, valorar el manejo nutricional de la obesidad en unidad de cuidados intensivos. Materiales y métodos: Revisión sistemática con declaración PRISMA 2020 con 39 artículos de bases de datos como PUBMED, ELSEVIER, PMC de los últimos 5 años sobre el tema de investigación. Resultados: La fisioterapia respiratoria postoperatoria en pacientes sometidos a cirugía bariátrica demostró que los pacientes mejoraron con la ventilación mecánica, el IMC se asoció con aumento de la incidencia de delirium. En pacientes críticamente enfermos con obesidad con extubación, el uso de VNI redujo el fracaso de la extubación, dieta de 1,5 g de proteína/kg de peso corporal ideal/día fue superior en fórmula nutrición enteral rica en proteínas (37 %) y baja en carbohidratos (29 %) comparada al control, proteínas (25 %) y carbohidratos (45 %). Discusión: La nutrición es uno de los factores más importantes como la administración de dietas con mayor cantidad de proteínas que carbohidratos, la fisioterapia respiratoria y la ventilación mecánica son la piedra angular del manejo critico de los pacientes obesos, desde una posición adecuada en Trendelenburg invertido, hasta el manejo con ventilación mecánica no invasiva.
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