Monitoreo de la perfusión tisular en pacientes con shock septico.
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Objetivo. Determinar la saturacion venosa central de oxigeno (SvcO2), la diferencia venoarterial de dioxido de carbono (Delta P(a-v)CO2) y el contenido arteriovenoso de oxigeno (Delta P(a-v)CO2/ C (a-v)O2) al ingreso en las primeras 24 hs de shock septico, para predecir mortalidad.
Adultos que ingresaron al STI polivalente con diagnóstico de shock septico (SS) desde el periodo comprendido entre marzo de 2016 y marzo 2017.
Resultados: 4 grupos de pacientes primeras 24 hs desde ingreso según los valores de SvcO2 Grupo 1: SvcO2 >70%, Delta P(a-v)CO2/C(a-v)O2 <1.4; Grupo 2: SvcO2 >70%, Delta P(a-v)CO2/C(a-v) O2 >1.4,Grupo 3: SvcO2 < 70%, Delta P(a-v)CO2/C(a-v) O2 <1.4,Grupo 4: SvcO2<70%, Delta P(a-v)CO2/C(a-v)O2 >1.4. Se evaluaron 80 pacientes que ingrearon al STI con SS , fueron excluidos 4 p que fallecieron en las 24 hs de su ingreso, la edad promedio 53+/- 16 años, la media de SAPS II 63 . el foco infeccioso mas prevalente fue pulmonar 35%. Los dias de ventilacion mecanica fueron 12 dias (3-21), la media de estancia en el STI fue de 14 (4 -23), requirieron 16 % de reemplazo renal, la mortalidad global fue del 36.8 %. En el analisis bivariado de se observó entre el grupo S y NS en las variables DP (a-v) CO2 4(3-5) versus 6.5 ( 4-9) p = 0.025 lactato >2(43%) versus (93%) p=0.003,SvcO2 <70% (21.7%) versus (50%) p=0.005 y Delta P (a-v) CO2/ C (a-v) >1.4 (43%) versus (79%) p=0.04 respectivamente. El resto de las variables no mostro diferencias significativas.
Conclusion: Los pacientes con SS que tienen SvcO2 <70% y Delta P(a-v)CO2/ C(a-v) >1.4 medidos en las 24hs de ingreso presentan mayor mortalidad a 30 dias
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BibliografÃa
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