ENTERALNA ISHRANA U SEPSI: DA LI MOŽEMO DA RAZBIJEMO MIT?
Sažetak
Sepsa je kompleksan poremećaj koji nastaje kao posledica neadekvatnog odgovora domaćina na infekciju i povezuje se sa akutnom disfunkcijom organa i visokim stepenom smrtnosti. Budući da je velik broj istraživanja u poslednjih trideset godina bio posvećen sepsi, upotrebom adekvatnih skorova i menjanjem postojećih omogućeno je brže prepoznavanje pacijenata sa sepsom. Septički šok se definiše kao perzistentna hipotenzija, refraktorna na nadoknadu tečnosti, koja zahteva upotrebu vazopresora, a praćena je cirkulatornim, metaboličkim i ćelijskim poremećajima.
Sepsa i septički šok povezani su sa kataboličkim odgovorom na stres, koji karakteriše sistemski inflamatorni odgovor praćen komplikacijama poput multiorganske disfunkcije, morbiditeta, produženog bolničkog lečenja i smrti. Malnutricija je, s obzirom na izraženi katabolizam u akutnoj fazi, česta pojava kod pacijenata sa sepsom. Enteralna ishrana je važna za podmirivanje energetskih potreba ovih pacijenata. Rana ishrana, prvenstveno enteralnim putem, danas se posmatra kao proaktivna terapijska strategija koja ima za cilj redukovanje težine bolesti, smanjenje komplikacija i dužine bolničkog lečenja i postizanje pozitivnog ishoda samog lečenja.
Sa enteralnom ishranom ne treba počinjati kod pacijenata sa hipotenzijom (MAP < 50 mmHg), kod kojih je tek započeta upotreba vazopresora ili kod kojih je povećana doza vazopresora. Preporučuje se da se enteralna ishrana zaustavi do hemodinamske stabilizacije. Rizici i benefiti enteralne ishrane moraju se uzeti u obzir kod svakog pojedinačnog pacijenta u stanju septičkog šoka. Noradrenalin u dozi < 0,3 mcg/kg/min smatra se bezbednim, a pacijent kome je data ova doza noradrenalina može se okarakterisati kao hemodinamski stabilan.
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