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2013, Número 1

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Med Crit 2013; 27 (1)


Identificación de factores de riesgo asociados a mortalidad en el paciente quirúrgico de alto riesgo en una Unidad de Cuidados Intensivos

Chávez PCE, Méndez LD, Muñoz RMR, Sánchez NVM

Idioma: Español
Referencias bibliográficas: 52
Paginas: 15-24
Archivo PDF: 126.04 Kb.


RESUMEN

Los pacientes quirúrgicos de alto riesgo comprenden 40% de las admisiones en el Departamento de Terapia Intensiva y son asociados con la presencia de complicaciones y alta mortalidad.
Objetivos: Conocer la asociación de factores de riesgo con mortalidad en pacientes quirúrgicos de alto riesgo en Unidad de Cuidados Intensivos.
Metodología: Se revisaron los expedientes de los pacientes quirúrgicos que ingresaron a la Unidad de Terapia Intensiva del Hospital San José del Tec de Monterrey, y que fueron sometidos a cirugía durante su estancia durante el 1 de enero de 2010 al 1 de enero de 2011, incluyéndose los que cumplan los criterios de alto riesgo. Se obtuvo la información correspondiente a cada variable. Se realizó el análisis estadístico mediante regresión logística multivariada para determinar las asociaciones.
Resultados: De 103 expedientes, únicamente 63 (61%) cumplieron con los criterios de alto riesgo quirúrgico. 61.9% (39) del género masculino y 38.1%(24) del femenino. La media de edad fue 59.22 DE 18.44. Aplicándose los criterios de pacientes quirúrgicos de alto riesgo, media de cumplimiento de 2.02 criterios ± 1.008. Acute Physiology and Chronic Health Evaluation II media 11.21 puntos ± 6.065 y Sequential Organ Failure Assessment media de 4.1 puntos ± 3.74. Mortalidad de 6 (9.5%). La estancia prequirúrgica 2.11 días ± 2.857, postquirúrgica de 14.48 días ± 14.2. Estancia en la Unidad de Cuidados Intensivos fue 16.68 ± 14.2. PaO2/FiO2 de 304.4, ± 118.764. 41 pacientes (65.1%) recibieron transfusiones. Acidosis 18 pacientes (28.6%). Lactato 2.658, ± 4.0271. Saturación venosa de O2 de 70.40% ± 14.117. Veinticuatro pacientes (54%) requirieron ventilación mecánica. La frecuencia cardiaca promedio 86.06 ± 20.121, presión arterial media 82.67 ± 13.956. Índice de masa corporal de 25.82 ± 5.03. 30 pacientes (47.6%) con nutrición prequirúrgica, 29 (96.6%) recibieron nutrición enteral, 1 (3.3%) recibió nutrición parenteral. Cincuenta pacientes (79.4%) recibieron nutrición postquirúrgica: 36 (72%) enteral, 12 (24%) parenteral y 2 (4%) nutrición mixta. Albúmina sérica 2.86 mg/dL ± 0.6649; colesterol 136.7 mg/dL ± 47.011. Delirio 6.3% 4 pacientes. Falla renal 6 pacientes (9.5%) de los cuales 2 (33.3%) se encontraban en «injury» y 4 (66.6%) en «failure». Las infecciones 17 de los pacientes (27%), en el 5.8% locales, 29.4% pulmonares, urinarias 5.8%, sepsis severa 35.29%, de origen abdominal 17.64% y otros sitios 5.8%. Posterior al análisis estadístico, sólo se encontraron las siguientes asociaciones significativas: el cumplimiento del número de criterios de gravedad (U 87, p 0.0492), el valor de la escala de Acute Physiology and Chronic Health Evaluation II (U 58.5 p 0.0084), el resultado de la escala Sequential Organ Failure Assessment con mortalidad (U 67, p 0.0149); los niveles de lactato (U 73, p 0.0341); la presencia de ventilación mecánica con mortalidad (p 0.0174), así como la presencia de infecciones (p 0.0011). Se realizó regresión logística, no se encontraron diferencias significativas en ninguna de las anteriores.
Conclusión: Existen factores de riesgo en el grupo de pacientes quirúrgicos de alto riesgo, como el número de criterios de alto riesgo, el uso de ventilación mecánica, los niveles de lactato, la no administración de nutrición prequirúrgica, la presencia de infecciones y los resultados de las escalas Sequential Organ Failure Assessment y Acute Physiology and Chronic Health Evaluation II, están asociados a mortalidad; sin embargo, ninguna de estas variables tienen mayor poder predictivo entre ellas.


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