López PHR, Poblano MM, Sánchez CC, Aguirre SJ, Franco GJ

Language: Spanish
References: 11
Page: 119-123
PDF size: 172.09 Kb.

ABSTRACT

Introduction: The perfusion of the coronary artery to the left ventricle occurs primarily during diastole. So there must be adequate diastolic pressure in the aortic root of both coronary arteries to be perfused. Maintaining an adequate coronary perfusion should be a primary goal in resuscitation of any patient in shock.
Aim: Determinate the correlation between hemodynamic parameters and the treatment shock with the coronary perfusion pressure (PPC) in the critically ill patients.
Methods: A retrospective study. We included all patients in a six month period with Swan-Ganz catheter. The statistical correlation of variables with PPC was assessed with a Pearson Test and ROC curve for discrimination of the test.
Results: We studied 28 patients, the APACHE II score was 19.6 ± 7.5; in the admission the PPC was 42.2 ± 10.8 mmHg, and had a inverse correlation with PAOP (p ‹ 0.001) and CVP (p = 0.001), regarding mortality it had a negative correlation with the PPC at admission (P = 0.022), the cutoff value for PPC for mortality was 42 mmHg with a sen 100% and spec 58% (p = 0.026 AUC .854). Also to the 24 h, the CVP and PAOP had a positive correlation with mortality (p = 0.016 and 0.026). To the 24 h, the PPC had a positive correlation with PAOP (p = 0.015). There was negative correlation between PPC and the use of inotropics and vasoactives but without significance.
Conclusion: It’s possible to estimate the PPC as a determinant of Reanimation as the PAOP, SVO₂, and CVP. We expect that a low value of PPC could guide the use of inotropic or vasoactives; this may also determine an index of the efficacy and/or impact of treatment on the management of critical care patient.

REFERENCES

1. Cheatham M. Cálculos hemodinámicos en www.surgicalcriticalcare.net/Lectures/hemodynamic_calculations.pdf

2. Barrera-Ramírez CF, y col. Fisiología coronaria y su utilidad para el cardiólogo intervencionista: Medición invasiva de la presión y flujo coronarios. Arch Cardiol Mex 2005;75:335-349.

3. Salavastru C, Carmaciu R. The role of the Gregg phenomenon in cardiac performance. Rom J Physiol 1998;35:253-7.

4. Feigl EO. Coronary autoregulation. J Hypertens 1989;7 (Suppl):S55-8.

5. Treistman B, Mesa A, Rozo JC, Anaya E. Medición de la reserva de flujo fraccional coronario: Principios generales y aplicación clínica. Revista Peruana de Cardiologia Enero-Abril 2002.

6. Hoffman MJ, Greenfield LJ, Sugerman HJ, Tatum JL. Unsuspected right ventricular dysfunction in shock and sepsis. Ann Surg 1983;198:307-319.

7. Calvin JE, Driedger AA, Sibbald WJ. The hemodynamic effect of rapid fluid infusion in critically ill patients. Surgery 1981;90:61-76.

8. Calvin JE, Driedger AA, Sibbald WJ. Does the pulmonary capillary wedge pressure predict left ventricular preload in critically ill patients? Crit Care Med 1981;9:437-443.

9. Baek SM, Makabali GG, Bryan-Brown CW, Kusek JM, Shoemaker WC. Plasma expansion in surgical patients with high central venous pressure (CVP); the relationship of blood volume to hematocrit, CVP, pulmonary wedge pressure, and cardiorespiratory changes. Surgery 1975;78:304-315.

10. Packman MI, Rackow EC. Optimum left heart filling pressure during fluid resuscitation of patients with hypovolemic and septic shock. Crit Care Med 1983;11:165-169.

11. Nelson LD, Rutherford EJ. Principles of hemodynamic monitoring. In: Pinsky MR, Dhainaut JF (Eds): Pathophysiologic foundations of critical care. Baltimore: Williams and Wilkins, 1993:3-22.