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2011, Number 1

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Rev Cub Med Int Emerg 2011; 10 (1)

Metabolic alterations and mortality in severe patient undergoes an invasive mechanical ventilation

Hernández PW, Pérez AJL, Jiménez PR, Parellada BJ, González GI

Language: Spanish
References: 51
Page: 2045-2067
PDF size: 251.41 Kb.


ABSTRACT

Introduction: The knowledge of metabolic alterations allows knowing the response ability of patients and the magnitude of aggression.
Objectives: To identify the metabolic alterations of severe patient undergone to invasive mechanical ventilation and its association with mortality, according to established profiles.
Method: A prospective, longitudinal and observational study was conducted in the patients admitted in Intensive Care Unit (ICU) of the “Dr. Luis Diaz Soto” Central Military Hospital underwent to invasive mechanical ventilation ≥ 72 hours. Patients were divided according to traumatic, clinical and surgical profile. At admission and daily for 72 hours the following procedures were applied: glycemia, urea, cholesterol, triglycerides and uric acid, urinary ureic nitrogen and creatinuria. Course was assessed according to mortality rate in ICU and in hospital. The non-parametric analysis was used, all under a 95 % IC or alpha = 0.05. A multivariate analysis was performed with implementation of logistic regression.
Results: The hyperglycemia (› 6.1 mmol/L), hypocholesterolemia (3.8 mmol/L), plasmatic urea and high urinary ureic nitrogen were present in all the diagnostic categories. Lower cholesterol figure corresponded to surgical profile (2.6 ± 1.29 mmol/L). The higher cholesterol figures of acid uric were present in the clinical profile (292.6 mmol/L) and in surgical one there were values higher of glycemia (8.13 ± 2.87 mmol/L and triglycerides (1.52 ± 0.76 mmol/L) as well as the minor ones of creatinuria (979 ± 399 mg/day and 14.12 ± 4.9 mg/kg/day).
Conclusions: The metabolic alterations showed an association with global mortality and according its category. In the Trauma the profiles were: A rise of urinary ureic nitrogen, plasmatic urea and triglycerides; as well as creatinuria with low values. In the clinical profile the high figures corresponded to uric acid, hyperglycemia and hypocholesterolemia. In the surgical one, the lowest values were the creatinuria, high plasmatic urea and hypocholesterolemia.


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