medigraphic.com
ISSN 1561-3194 (Electronic)

2015, Number 6

<< Back Next >>

Rev Ciencias Médicas 2015; 19 (6)

Markers of tissular hypoperfusion and its relationship with mortality in patients with septic shock

García BA, Miranda PY, Breijo PA, Ramos RE, Álvarez DE

Language: Spanish
References: 12
Page: 1075-1083
PDF size: 1467.62 Kb.


ABSTRACT

Introduction: septic shock results in many deaths, and microcirculatory guided therapy could improve mortality variables.
Objective: to determine the relationship between the markers of tissular hypoperfusion and the mortality in patients admitted with the diagnosis of septic shock in the intensive care units of Abel Santamaría Cuadrado General Teaching Hospital from September 2013 to April 2015.
Material and Methods: A descriptive, cross-sectional prospective study was conducted with patients suffering from septic shock who were admitted to the ICU. Data were obtained from medical records; the universe comprised 168 patients diagnosed with septic shock, the sample included 35 patients older than 18 years old admitted within the 6 hours, excluding seriously-ill new mothers.
Results: microcirculatory markers were more related to mortality than the microcirculation, being highly significant and in response to the resuscitation at 24 hours significantly. The ratio of the arterial O2 saturation less than 75% and the central venous O2 saturation less than 70% win relation to the mortality was very significant. Patients who presented an arteriovenous difference greater CO2b equal to 6 mmHg, and an excess of basis less than -4 bases died, being very significant.
Conclusions: to guide the therapeutic behavior by microcirculatory hemodynamic markers that predict mortality rates and to carry out an appropriate conduct with patients suffering from septic shock, reducing complications and deaths.


REFERENCES

  1. Manji RA, Wood KE, Kumar DA. The history and evolution of circulatory shock. Crit Care Clin [Internet]. 2009 jan [citado 12 Feb 2014]; 25:30. Disponible en: http://www.sciencedirect.com/science/article/pii/S0749070408000900

  2. Neviere R. Sepsis and the systemic inflammatory response syndrome: Definitions, epidemiology, and prognosis [Internet]. 2010 [citado 14 Dic 2013]. Disponible en: http://www.uptodateol.com/patients/content/topic.do?topicKey=~srXrizHlaQggs

  3. Dellinger RP, Levy MM, Carlet JM. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med [Internet]. 2012 [citado 01 Feb 2014]; 36(1): 324. Disponible en: http://link.springer.com/article/10.1007/s00134-012-2769-8

  4. Mesquida J, Borrat X, Lorente JA, Masip J, Baigorri F. Objetivos de la reanimación hemodinámica. Med Intensiva [Internet]. 2011 [citado 12 Feb 2015]; 35:9. Disponible en: http://www.sciencedirect.com/science/article/pii/S0210569110002755

  5. Mateu Campos M, Ferrándiz Sellés A, Gruartmoner de Vera G, Mesquida Febrer J, Sabatier Cloarec C, Poveda Hernández Y, et al. Técnicas disponibles de monitorización hemodinámica. Ventajas y limitaciones. Med Intensiva [Internet]. 2012 [citado 17 Feb 2015]; 36:10. Disponible en http://www.medintensiva.org/es/linkresolver/tecnicas-disponibles-monitorizacionhemodinamica- ventajas/S0210-5691%2812%2900184-2/

  6. Ochagavía A, Baigorri F, Mesquida J, Ayuela JM, Ferrándiz A, García X, et al. Monitorización hemodinámica en el paciente crítico. Recomendaciones del Grupo de Trabajo de Cuidados Intensivos Cardiológicos y RCP de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias. Med Intensiva [Internet]. 2014 [citado 17 Feb 2015]; 38(3): 154-69. Disponible en: http://linkinghub.elsevier.com/retrieve/pii/S0210569113002234?via=sd

  7. Van Beest PA, Lont MC, Holman ND, Loef B, Kuiper MA, Boerma EC. Central venous-arterial pCO2 difference as a tool in resuscitation of septic patients. Intensive Care Med [Internet]. 2013 [citado 12 Feb 2014]; 39:6. Disponible en: http://link.springer.com/article/10.1007/s00134-013-2888-x 8.Gruartmoner G, Mesquida J, Baigorri F. Saturación tisular de oxígeno en el paciente crítico. Med Intensiva [Internet]. 2014 [citado 12 Feb 2014]; 38(4): 240-

  8. Disponible en: http://linkinghub.elsevier.com/retrieve/pii/S0210569113001599?via=sd

  9. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goaldirected therapy in the treatment of severe sepsis and septic shock. N Engl J Med [Internet]. 2011 [citado 12 Feb 2015]; 345:9. Disponible en http://www.nejm.org/doi/full/10.1056/nejmoa010307

  10. Vallee F, Vallet B, Mathe O, Parraguette J, Mari A, Silva S, et al. Central venous-to-arterial carbon dioxide difference: An additional target for goal-directed therapy in septic shock. Intensive Care Med [Internet]. 2012 [citado 15 Feb 2015]; 34:8. Disponible en http://link.springer.com/article/10.1007/s00134-008-1199-0

  11. Van Beest PA, Lont MC, Holman ND, Loef B, Kuiper MA, Boerma EC. Central venous-arterial pCO2 difference as a tool in resuscitation of septic patients. Intensive Care Med [Internet]. 2013 [citado 15 Feb 2015]; 39: 1034-9. Disponible en: http://link.springer.com/article/10.1007/s00134-013-2888-x

  12. Montassier E, Batard E, Segard J, Hardouin JB, Martin A, Le Conte P, et al. Base excess is an accurate predictor of elevated lactate in ED septic patients. Am J Emerg Med [Internet]. 2012 [citado 20 Feb 2014]; 30:3. Disponible en: http://www.sciencedirect.com/science/article/pii/S0735675710004754




2020     |     www.medigraphic.com