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2016, Número 1

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Med Crit 2016; 30 (1)


Delta de CO2 como factor de riesgo de muerte en choque séptico

Ocelotl PR, Valle RJ, De Jesús BD, Cortés MJA, Herrera MBE, Mendoza RM

Idioma: Español
Referencias bibliográficas: 31
Paginas: 30-42
Archivo PDF: 569.13 Kb.


RESUMEN

Introducción: La sepsis severa y choque séptico constituyen un problema de salud pública por su alta prevalencia y mortalidad. La diferencia arteriovenosa de CO2 (DCO2) bajo condiciones fisiológicas no excede más de 0.8 kPa (6 mmHg), reflejando adecuado flujo venoso y volumen cardiaco. A nivel macrocirculatorio existe una relación inversa entre DCO2 e IC en pacientes críticos. El objetivo de este trabajo es determinar el riesgo de muerte a corto plazo con DCO2 mayor a 6 mmHg en pacientes con choque séptico que ingresan al Servicio de Terapia Intensiva del Hospital General «La Villa» de la Ciudad de México.
Material y métodos: Estudio longitudinal, descriptivo. Incluimos pacientes con choque séptico y sin falla cardiaca aguda al momento del ingreso, mayores de 18 años. Variables: delta CO2; lactato, SvcO2, sitios de infección. Analizamos el DCO2 › a 6 mmHg al ingreso a las 6 y 12 horas. Se calculó riesgo relativo para mortalidad a corto plazo.
Resultados: Fueron 42 pacientes, 30 hombres y 12 mujeres con edad promedio de 39 años. Sitios de infección: urinario en 18 pacientes, abdominal en 12, respiratorio en 6 y en tejidos blandos 6. Todos los pacientes que fallecieron tuvieron delta CO2 › 6 mmHg al ingreso y a las 6 horas y 20 pacientes a las 12 horas.
Conclusión: El riesgo relativo de muerte a corto plazo en pacientes con DCO2 › 6 mmHg se incrementa importantemente cuando éste se mantiene elevado a través del tiempo.


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