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2023, Number 4

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Med Crit 2023; 37 (4)

Usefulness of the protocol for the management of severe obstetric patients guided by ultrasound (POGGU) in patients codigo mater

Hernández AJT, Montelongo FJ, Galindo AJ, Tapia VR, Alva ANV

Language: Spanish
References: 20
Page: 291-298
PDF size: 356.93 Kb.


ABSTRACT

Introduction: maternal mortality can still be considered an important public health problem in our country, within the strategies implemented to reduce morbidity-mortality, the code mater is created for our intensive therapy, based on care algorithms, where a cornerstone is the early and timely diagnosis, gaining relevance the use of ultrasound as a diagnostic m ethod in severe obstetric patients. In our unit, an ultrasound protocol was developed aimed at the assessment of severe obstetric patients, called protocol in severe obstetric patient guided by ultrasound or POGGU protocol. Objective: to determine if the Poggu protocol is useful for diagnostic integration and management of these patients. Material and methods: retrospective, analytical cross-sectional study, 507 patients were included in a period of 7 years, where once the mater code was activated, they went to the evaluation in search of symptoms and cardinal signs, depending on these, proceeded to carry out point of care ultrasonography, determining classes of intervention, bivariate analysis was performed, Student's t or Mann-Whitney U tests were used for continuous and discrete quantitative variables and Pearson's χ2 test for categorical and nominal ones. Variables were correlated between the types of categories and point of care ultrasounds and finally a multivariate analysis of binary logistic regression adjusted for variables with statistical and clinical significance. Results: it was obtained that grades II, III, and IV showed an association, reaching significance against point of care ultrasonography, based on the diagnosis (grade II) in 65/35 in abdominal, with a p = 0.000; pulmonary of 81/19, with a p = 0.015; heart rate of 82/18, with a p = 0.022; large vessels and response to volume of 57/43, with a p = 0.000. A usefulness was found in providing additional information (grade III) with p = 0.000, and in which ultrasonography was decisive for management (grade IV) with p = 0.000, finally, in the logistic regression a result was obtained squared or adjusted R of 0.50, that is, 50%, with an omnibus of p = 0.0001, finding that there is a moderate relationship between degrees and cardiac point of care ultrasonography and great vessels with response to volume. Conclusions: 99.6% of our studied population survived being operated on with the POGGU protocol within the multidisciplinary rapid response care process code mater. In 97.2% of the patients, at least one ultrasound window was obtained for patient assessment, an important fact, since it tells us about the ease of its realization, its implementation is suggested when activating the mater code, not only as an option, if not essential (making it an integral part of the obstetric triage technical guideline, maternal code and obstetric immediate response team), the use of ultrasound should be considered as an essential part of the intensivist's work when assessing an obstetric patient serious.


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