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2018, Número 1

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Med Crit 2018; 32 (1)


Clasificación del choque séptico a partir de los iones no medidos

Pin GE, Sánchez DJS, Martínez REA, García MRC, Peniche MKG, Calyeca SMV

Idioma: Español
Referencias bibliográficas: 43
Paginas: 13-19
Archivo PDF: 233.61 Kb.


RESUMEN

Introducción: El choque séptico es la principal causa de choque en la Unidad de Cuidados Intensivos (62% de todos los casos), su mortalidad es alrededor de 40 a 50%. En los pacientes con choque séptico, la acidosis metabólica es el trastorno ácido-base más común. La estratificación del riesgo en los pacientes críticamente enfermos nos permite identificar pacientes con mayor probabilidad de ser beneficiados con el tratamiento.
Material y métodos: Se realizó un estudio de cohorte, prospectivo, longitudinal, observacional y analítico. Se incluyeron pacientes con diagnóstico de choque séptico (según las guías de la campaña Sobreviviendo a la Sepsis del año 2016) y acidosis metabólica, ingresados a la Unidad de Cuidados Intensivos en el periodo comprendido entre junio de 2015 y julio de 2017.
Resultados: Los iones no medidos (RR 2.5, IC 95% 1.03-6.2, p = 0.0001) son predictores independientes de supervivencia al ingreso a la Unidad de Cuidados Intensivos (UCI). Del total de defunciones (n = 28), el número y porcentaje fue diferente entre cada clase: clase I (n = 2, 7%), clase II (n = 6, 21%), clase III (n = 9, 32%) y clase IV (n = 11, 39%).
Conclusión: El objetivo de clasificar a los pacientes con choque séptico y acidosis metabólica a su ingreso es comparar grupos para dirigir el esfuerzo terapéutico de la mejor manera. Los iones no medidos son una buena opción, tienen sustento científico; además, pueden evaluar y clasificar pacientes con choque séptico y acidosis metabólica en hospitales como el nuestro, donde la medición de lactato no se puede realizar. Los resultados adversos son mayores en el choque séptico clase IV (› -9 mEq/L), según los iones no medidos.


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