Medidas de resucitación precoz durante la pandemia de gripe a (H1N1). Se beneficiaron los pacientes?
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Medidas de resucitación precoz durante la pandemia de gripe a (H1N1). Se beneficiaron los pacientes?
Medidas de resucitación precoz durante la pandemia de gripe a (H1N1). Se beneficiaron los pacientes?

Palabras clave

Pandemia gripe A H1N1
Sepsis
resucitacion inicial en sepsis

Cómo citar

1.
DUARTE DA. Medidas de resucitación precoz durante la pandemia de gripe a (H1N1). Se beneficiaron los pacientes?. Rev Arg de Ter Int. [Internet]. 17 de noviembre de 2011 [citado 22 de junio de 2024];28(4). Disponible en: https://revista.sati.org.ar/index.php/MI/article/view/282

Resumen

Objetivo: Evaluar el impacto en la utilización de un protocolo de medidas de detección y resucitación precoz durante la pandemia H1 N1 sobre el ingreso de pacientes al Servicio de Terapia Intensiva (STI). Diseño: Estudio observacional y retrospectivo de pacientes críticos. Ámbito: Un STI médico-quirúrgica. Pacientes: Adultos ingresados al STI desde el Servicio de Urgencia (SU) entre el 28 de abril 2009 al 04 de setiembre 2009. Variables de interés principal: Sexo, edad, comorbilidades, APACHE II, SOFA score de ingreso al STI (Sepsis- related Organ Failure Assesment), sintomatología clínica, imágenes radiográficas, necesidad de asistencia respiratoria mecánica (NARM), Ac. Láctico (mg/dl) (AL),Creatinfososquinasa (CPK) (U/l), lacticodeshidrogenas (LDH) (U/l), leucocitosis, Saturación de O2 al ingreso al STI ( Sat.O2), PaO2/FiO2 ingreso STI, presión al final de la espiración(PEEP), días de ARM (DARM),tratamiento con oseltamivir (dosis/ tiempo),Aislamiento Bacteriológico (AB) y Virológico (AV) en secreción bronquial, tratamiento con corticoides, estadía en TI (ET), y Mortalidad (M).Resultados: Se incluyeron 13 pacientes ingresados al STI en el periodo estudiado, donde la edad media fue: 45 +/- 3, sexo femenino n=8  61.5%, comorbilidades n= 7  53.8%,  (EPOC n=3, DBT n= 2, Insuficiencia Cardiaca n=1, Cirrosis n= 1), APACHE II: 18, SOFA de Ingreso 9+/-2, la sintomatología clínica predominante fue la: Fiebre n= 13  100%, tos n=11 84.6%, disnea n= 9  69.2%, infiltrados interticiales 5/13  38.4 %, opacidades alveolares 6/13  46.1%, opacidades mixtas 2/13  15.3%, 4 cuadrantes 9/13   69.2% y 2 cuadrantes 4/13  30.7%, la media de: AL 25 mg/dl, CPK 480(U/l) (p< 0.05), LDH 2100 (U/l) (p< 0.001), leucocitosis 12.500 mm3,PEEP 18 cmH2O, Sat. O2 < 91 % n=11   84.6%, PaO2/FiO2 < 150 n=11  84.6%, NARM n=11  84.6%, DARM 9.5 +/- 3 días, Oseltamivir: dosis150 mg/12 hs.; AB (Neumococo: n= 7  53.8%); AV (H1 N1: n= 5  38.4%) duración: 9.5+/- 3 días, Corticoides n=8  61.5%.  ET 11+/-4, no se registro fallecidos. Conclusión: En el grupo estudiado la aplicación de un protocolo que evalúo la gravedad beneficio en la correcta evaluación y resucitación inicial. Los valores de CPK, LDH se acompaño de mayor gravedad gasométrica y compromiso radiológico en la radiología de tórax.


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