Pascual ES, Sánchez DJS, Peniche MKG, Martínez REA, Villegas DJE, Calyeca SMV

Idioma: Español
Referencias bibliográficas: 37
Paginas: 344-350
Archivo PDF: 398.36 Kb.

RESUMEN

Introducción: Desde que se documentaron las alteraciones del flujo sanguíneo a nivel microvascular en los pacientes con choque séptico, numerosos estudios a través de los años se han encargado de establecer el impacto pronóstico de dichas alteraciones en este grupo de pacientes.
Material y métodos: Se realizó un estudio de cohorte ambispectivo, longitudinal, descriptivo y analítico en pacientes con diagnóstico de choque séptico ingresados a la Unidad de Cuidados Intensivos (UCI) en el periodo comprendido entre el 15 de junio de 2015 y el 30 de julio de 2018. Los pacientes se clasificaron al ingreso en SvcO₂ ≥ 80% (choque séptico hiperdinámico) y SvcO₂ ‹ 80% (choque séptico normodinámico). Se utilizaron las variables de perfusión tisular lactato, Δp(v-a)CO₂, Δp(v-a)CO₂ /Δ(a-v)O₂ y ERO₂. Todos los análisis estadísticos se realizaron con el programa SPSSTM 22.0.
Resultados: En el periodo considerado, 82 pacientes cumplieron con los criterios de inclusión; de ellos, 60 (73.1%) se clasificaron como estado de choque normodinámico y 22 (26.9%) como hiperdinámico. El análisis multivariado reportó el ERO₂ con OR 20.373 (IC 95%: 2.451-169.320; p = 0.005), el lactato con OR 0.533 (IC 95%: 0.146-1.948; p = 0.341), el Δ(v-a)CO₂ con OR 4.848 (IC 95%: 1.201-19.565; p = 0.027) y el Δ(v-a)CO2/Δ(a-v)O2 con OR 0.276 (IC 95%: 0.058-1.309; p = 0.105).
Conclusión: Los pacientes con choque séptico presentan alteraciones de la perfusión tisular y la microcirculación; estas alteraciones no dependerán del estado hemodinámico (hiperdinamia o normodinamia) del paciente. Con una gasometría arterial y una gasometría venosa central podemos valorar la perfusión tisular y la microcirculación, midiendo variables como lactato, Δp(v-a)CO₂, Δp(v-a)CO₂/Δ(a-v)O₂ y ERO₂ sin necesidad de dispositivos sofisticados.

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