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2023, Number 5

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Med Crit 2023; 37 (5)

Transoperative arterial blood gas and serum lactate values in patients with obstetric hemorrhage admitted to an intensive care unit

Díaz-Aguilar FA, Penagos-Hernández DH, Flores-Meza MÁ

Language: Spanish
References: 28
Page: 411-418
PDF size: 205.26 Kb.


ABSTRACT

Introduction: obstetric hemorrhage is one of the main causes of maternal morbidity and mortality in the world. Currently there are no tools to anticipate this situation and its respective complications, at the moment data used in trauma patients are transpolated without taking into account the physiological changes of pregnancy, hence the need to obtain closer values in the acute event of obstetric hemorrhage. such as serum lactate, arterial blood gases and adjusting therapeutic needs to act in a timely manner and avoid further complications. Material and methods: an observational, retrospective, descriptive, cross-sectional and analytical study was carried out, where the clinical records of patients admitted to the Intensive Care Unit (ICU) of the obstetrics and gynecology hospital of the national medical center "La Raza" in the years 2020 and 2021. Demographic variables, comorbidities, laboratory values, complications and treatment were recorded. Two groups with hemorrhage greater and less than 3,000 milliliters were formed, performing bivariate analysis. The statistical analysis was carried out with the SPSS 25 program. Results: in the period considered, 69 records met the inclusion criteria, finding an average age of 33 years, average gestational weeks (AGW) of 34.18, preeclampsia (PES) 19 (27.1%), chronic arterial hypertension (HAS) and gestational hypertension. (HG) 7 (10%), diabetes (DM) 11 (15%), emergency surgery 68 (97%), caesarean sections 60 (85%), hysterectomy 41 (58.6%), use of mechanical ventilation 11 (15%), renal failure 11 (15%), disseminated intravascular coagulation 3 (4%), and mortality 4 (5.7%). Statistically significant differences were found in the groups with hemorrhage less than 3,000 mL and with hemorrhage greater than 3,000 mL, 35 and 34 patients respectively, observing the following significance: bleeding: 2,057 mL (IQR 1,600 mL) versus 5,000 mL (IQR 4,000 cm3) p = 0.001, pH 7.35 (IQR 7.31) vs 7.29 mg/dL (IQR 7.18) p = 0.001, arterial carbon dioxide (PaCO2) pressure 32.8 (IQR 29.5) vs 38.3 (IQR 38.3) p = 0.02, base excess (BE) -7.97 mmol/L (IQR -9.6) versus -0.95 mmol/L (IQR -10.5) p = 0.024, lactate 2.4 mmol/L (IQR 1.7) versus 3.1 mmol/L (IQR 2.4) p = 0.010, crystalloids in the operating room 3,327 cm3 (IQR 2,350) versus 3,500 cm3 (IQR 3,150) p = 0.007, operating room colloids 157 cm3 (IQR 0) versus 500 cm3 (IQR 0) p = 0.002. Conclusions: as our unit is a reference hospital and has a high-risk population, a higher frequency of radical surgical treatment is observed. In our patients in a state of hypovolemic shock, it is the cause of cellular and tissue hypoperfusion, which produces a decrease in pH, bicarbonate, as well as hypoxemia and greater base deficit and hyperlactatemia. Therefore, the gasometric study is a useful study for decision-making. decisions in resuscitation treatment.


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