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2017, Número 4

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Rev Mex Anest 2017; 40 (4)


Débito de oxígeno perioperatorio

Peña-Pérez CA

Idioma: Español
Referencias bibliográficas: 65
Paginas: 273-279
Archivo PDF: 212.82 Kb.


RESUMEN

Está bien establecido que una intervención quirúrgica conlleva a la rápida activación de la respuesta al estrés en un organismo vivo. Esta respuesta produce un aumento inmediato en la liberación de la hormona adrenocorticotrópica, liberación de cortisol, resistencia a la insulina y en los niveles séricos de catecolaminas. Además, esta respuesta al estrés es responsable de un aumento en el consumo de oxígeno. En la década de los 90, Shoemaker demostró el desarrollo de una deuda de oxígeno en la fase transoperatoria en pacientes quirúrgicos de alto riesgo y que, en aquellos pacientes que no fueron capaces de superar este déficit durante las primeras horas del postoperatorio, se observó un incremento significativo de la morbilidad y mortalidad. También observó que la incidencia de falla orgánica y muerte se redujo cuando el déficit de oxígeno se compensó rápidamente mediante la optimización de variables hemodinámicas utilizando un protocolo dirigido a alcanzar los mismos valores hemodinámicos registrados en los pacientes que sobrevivieron. Estos datos demostraron claramente que algunos pacientes necesitan apoyo hemodinámico para superar el estrés quirúrgico. Por lo tanto, en las últimas décadas, se han desarrollado varios protocolos para optimizar los parámetros hemodinámicos con el objetivo de reducir la hipoperfusión tisular y satisfacer las crecientes demandas metabólicas del tejido lo antes posible.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372:139-144.

  2. Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet. 2012;380:1059-1065.

  3. Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med. 2009;361:1368-1375.

  4. Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242:326-341.

  5. Jacobs DO. Variation in hospital mortality associated with inpatient surgery-an SOS. N Engl J Med. 2009;361:1398-1400.

  6. Cecconi M, Corredor C, Arulkkumaran N, et al. Clinical review: goal-directed therapy-what is the evidence in surgical patients? The effect on different risk groups. Crit Care. 2013;17:209.

  7. Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. 2011;112:1392-1402.

  8. Dalfino G, Giglio MT, Puntillo F, Marucci M, Brienza N. Haemodynamic goal-directed therapy and postoperative infections: earlier is better. A systematic review and meta-analysis. Crit Care. 2011;15:R154.

  9. Gurgel ST, do Nascimento P Jr. Maintaining tissue perfusion in high-risk surgical patients: a systematic review and randomized clinical trials. Anesth Analg. 2011;112:1384-1391.

  10. Grocott MP, Dushianthan A, Hamilton MA, Mythen MG, Harrison D, Rowan K, et al. Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a Cochrane Systematic Review. Br J Anaesth. 2013;111:538-548.

  11. Jhanji S, Thomas B, Ely A, Watson D, Hinds CJ, Pearse RM. Mortality and utilization of critical care resources amongst high-risk surgical patients in a large NHS trust. Anaesthesia. 2008;63:695-700.

  12. Shoemaker WC, Appel PL, Bland R, Hopkins JA, Chang P. Clinical trial of an algorithm for outcome prediction in acute circulatory failure. Crit Care Med. 1982;10:390-397.

  13. Shoemaker WC, Appel PL, Waxman K, Schwartz S, Chang P. Clinical trial of survivors’ cardiorespiratory patterns as therapeutic goals in critically ill postoperative patients. Crit Care Med. 1982;10:398-403.

  14. Shoemaker WC, Appel PL, Kram HB. Tissue oxygen debt as a determinant of lethal and nonlethal postoperative organ failure. Crit Care Med. 1988;16:1117-1120.

  15. Boyd O, Grounds RM, Bennett ED. A randomized clinical trial of the effects of deliberate perioperative increase of oxygen delivery on mortality in high risk surgical patients. JAMA. 1993;270:2699-2707.

  16. Rhodes A, Cecconi M, Hamilton M, Poloniecki J, Woods J, Boyd O, et al. Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study. Intensive Care Med. 2010;36:1327-1332.

  17. Lindahl SG. Energy expenditure and fluid and electrolyte requirements in anesthetized infants and children. Anesthesiology. 1988;69:377-382.

  18. Marik PE, Kauffman D. The effects of neuromuscular paralysis on sistemyc and splanchnic oxygen utilization in mechanically ventilated patients. Chest. 1996;109:1038-1042.

  19. Bacher A, Illevich UM, Fitzgerald R, Ihra G, Spiss CK. Changes in oxygenation variables during progressive hypothermia in anesthetized patients. J Neurosurg Anesthesiol. 1997;9:205-210.

  20. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109:318-338.

  21. Shepherd SJ, Pearse RM. Role of central and mixed venous oxygen saturation measurement in perioperative care. Anesthesiology. 2009;111:649-656.

  22. Collaborative Study Group on Perioperative ScvO2 Monitoring. Multi-centre study on peri- and postoperative central venous oxygen saturation in high-risk surgical patients. Crit Care. 2006;10:R158.

  23. Futier E, Robib E, Jabaudon M, Guerin R, Petit A, Bazin JE, et al. Central venous O2 saturation and venous-to-arterial CO2 difference as complementary tools for goal-directed therapy during high-risk surgery. Crit Care. 2010;14:R193.

  24. Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED. Changes in central venous saturation after major surgery, and association with outcome. Crit Care. 2005;9:R694-699.

  25. Salzwedel C, Puig J, Carstens A, Bein B, Molnar Z, Kiss K, et al. Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study. Crit Care. 2013;17:R191.

  26. Marik PE. Noninvasive cardiac output monitors: a state-of-the-art review. J Cardiothorac Vasc Anesth. 2013;27:121-134.

  27. Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013;119:507-515.

  28. Chawla LS, Zia H, Gutierrez G, Katz NM, Seneff MG, Shah M. Lack of equivalence between central and mixed venous oxygen saturation. Chest. 2004;126:1891-1896.

  29. Dueck MH, Klimek M, Apprenrodt S, Weigand C, Boerner U. Trends but not individual values of central venous oxygen saturation agree with mixed venous oxygen saturation during varying hemodynamic conditions. Anesthesiology. 2005;103:249-257.

  30. Reinhart K, Rudolph T, Bredle DL, Hannemann L, Cain SM. Comparison of central-venous to mixed-venous oxygen saturation during changes in oxygen supply/demand. Chest. 1989;95:1216-1221.

  31. Lorentzen AG, Lindskov C, Sloth E, Jakobsen CJ. Central venous oxygen saturation cannot replace mixed venous saturation in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2008;22:853-857.

  32. Glamann DB, Lange RA, Hillis LD. Incidence and significance of a “step-down” in oxygen saturation from superior cava to pulmonary artery. Am J Cardiol. 1991;68:695-697.

  33. Barratt-Boyes BG, Wood EH. The oxygen saturation of blood in the venae cavae, right-heart, chambers, and pulmonary vessels of healthy subjects. J Lab Clin Med. 1957;50:93-106.

  34. Dahn MS, Lange MP, Jacobs LA. Central mixed and splanchnic venous oxygen saturation monitoring. Intensive Care Med. 1988;14:373-378.

  35. Lee J, Wright F, Barber R, Stanley L. Central venous oxygen saturation in shock: a study in man. Anesthesiology. 1972;36:472-478.

  36. Ho KM, Harding R, Chamberlain J, Bulsara M. A comparison of central and mixed venous oxygen saturation in circulatory failure. J Cardiothorac Vasc Anesth. 2010;24:434-439.

  37. Turnaoğlu S1, Tuğrul M, Camci E, Cakar N, Akinci O, Ergin P. Clinical applicability of the substitution of mixed venous oxygen saturation with central venous oxygen saturation. J Cardiothorac Vasc Anesth. 2001;15:574-579.

  38. Reinhart K, Kersting T, Fohring U, Schafer M. Can central-venous replace mixed-venous oxygen saturation measurements during anesthesia? Adv Exp Med Biol. 1986;200:67-72.

  39. Pölönen P1, Ruokonen E, Hippeläinen M, Pöyhönen M, Takala J. A prospective, randomized study of goal-oriented hemodymaic therapy in cardiac surgical patients. Anesth Analg. 2000;90:1052-1059.

  40. Donatu A, Loggi S, Preiser JC, Orsetti G, Munch C, Gabbanelli V, et al. Goal-directed intraoperative therapy reduces morbidity and length of hospital stay in high-risk surgical patients. Chest. 2007;132:1817-1824.

  41. Van der Linden P, Schmartz D, Gilbart E, Engelman E, Vincent JL. Effects of propofol, etomidate, and pentobarbital on critical oxygen delivery. Crit Care Med. 2000;28:2492-2499.

  42. Perz S, Uhlig T, Kohl M, Bredle DL, Reinhart K, Bauer M, et al. Low and “supranormal” central venous oxygen saturation and markers of tissue hypoxia in cardiac surgery patients: a prospective observational study. Intensive Care Med. 2011;37:52-59.

  43. Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL. Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg. 1996;171:221-226.

  44. Smith I, Kumar P, Molloy S, Rhodes A, Newman PJ, Grounds RM, et al. Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med. 2001;27:74-83.

  45. Blow O, Magliore L, Claridge JA, Butler K, Young JS. The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma. J Trauma 1999; 47:964-969.

  46. Meregalli A, Oliceira RP, Friedman G. Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients. Crit Care. 2004;8:R60-R65.

  47. Howell M, Donnino M, Clardy P, Talmor D, Shapiro N. Occult hypoperfusion and mortality in patients with suspected infection. Intensive Care Med. 2007;33:1892-1899. doi: 10.1007/s00134-007-0680-5.

  48. Lavery RF, Livingston DH, Tortella BJ, Sambol JT, Slomovitz BM, Siegel JH. The utility of venous lactate to triage injured patients in the trauma center. J Am Coll Surg. 2000;190:656-664.

  49. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knobblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368-1377.

  50. Hucker TR, Mitchell GP, Blake LD, Cheek E, Bewick V, Grocutt M. Identifying the sick; can biochemical measurements be used to aid decision making on presentation to the accident and emergency department. Br J Anaesth. 2005;94:735-741.

  51. Vincent JL, Dufaye P, Berré J, Leeman M, Degaute JP, Kahn RJ. Serial lactate determinations during circulatory shock. Crit Care Med. 1983;11:449-451.

  52. Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004;32:1637-1642.

  53. Weil MH, Michaels S, Rackow EC. Comparison of blood lactate concentrations in central venous, pulmonary artery, and arterial blood. Crit Care Med. 1987;15:489-490.

  54. Brinkert W, Rommes JH, Bakker J. Lactate measurements in critically ill patients with a hand-held analyser. Intensive Care Med. 1999;25:966-969.

  55. De Backer D, Zhang H, Vincent JL. Models to study the relation between oxygen consumption and oxygen delivery during an acute reduction in blood flow: comparison of balloon filling in the inferior vena cava, tamponade, and hemorrhage. Shock. 1995;4:107-112.

  56. Ronco JJ, Fenwick JC, Tweeddale MG, Wiggs BR, Phang PT, Cooper DJ, et al. Identification of the critical oxygen delivery for anaerobic metabolism in critically ill septic and nonseptic humans. JAMA. 1993;270:1724-1730.

  57. Haji-Michael PG, Ladriere L, Sener A, Vincent JL, Malaisse WJ. Leukocyte glycolysis and lactate output in animal sepsis and ex vivo human blood. Metabolism. 1999;48:779-785.

  58. Levy B, Gibot S, Franck P, Cravoisy A, Bollaert PE. Relation between muscle Na+K+ ATPase activity and raised lactate concentrations in septic shock: a prospective study. Lancet. 2005;365:871-875.

  59. Vary TC. Sepsis-induced alterations in pyruvate dehydrogenase complex activity in rat skeletal muscle: effects on plasma lactate. Shock. 1996;6:89-94.

  60. Iscra F, Gullo A, Biolo G. Bench-to-bedside review: lactate and the lung. Crit Care. 2002;6:327-329.

  61. Routsi C, Vincent JL, Bakker J, De Backer D, Lejeune P, d’Hollander A, et al. Relation between oxygen consumption and oxygen delivery in patients after cardiac surgery. Anesth Analg. 1993;77:1104-1110.

  62. Friedman G, De Backer D, Shahla M, Vincent JL. Oxygen supply dependency can characterize septic shock. Intensive Care Med. 1998;24:118-123.

  63. Rossi AF, Khan DM, Hannan R, Bolivar J, Zaidenweber M, Burke R. Goal-directed medical therapy and point-of-care testing improve outcomes after congenital heart surgery. Intensive Care Med. 2005;31:98-104.

  64. Ince C. The microcirculation is the motor of sepsis. Crit Care. 2005;9:S13-S19.

  65. De Backer D, Creteur J, Dubois MJ, Sakr Y, Koch M, Verdant C, Vincent JL. The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med. 2006;34:403-408.




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