학술논문
Valor pronóstico del índice de saturación tisular de oxígeno (rso2) como expresión de la oxigenación tisular en pacientes con sepsis secundaria a neumonia adquirida en la comunidad.
Document Type
Dissertation/Thesis
Author
Source
TDX (Tesis Doctorals en Xarxa)
Subject
616.9
Language
Spanish; Castilian
Abstract
Introducción: La neumonía adquirida en la comunidad es una infección alveolar que se desarrolla en pacientes que se encuentran en el ámbito comunitario. A pesar de los avances, sigue siendo una importante causa de morbimortalidad en el mundo. Es importante encontrar la forma de detectar de forma precoz el grupo de pacientes que presenta peor pronóstico. En este contexto, nuestra investigación ha estudiado la oxigenación tisular como un indicador indirecto de la microcirculación que puede servir para detectar de forma precoz pacientes con riesgo de presentar complicaciones. Método: se incluyeron pacientes que ingresaron en UCI con diagnóstico de neumonía comunitaria y se realizaron determinaciones del índice de saturación tisular de oxígeno (rSO2) mediante tecnología de espectroscopia cercana al infrarrojo. Se determinó la asociación de esta variable con otras variables hemodinámicas clásicas y el valor predictivo de las variables para mortalidad. Resultados: la presencia de un rSO2 bajo se asoció a mayor mortalidad en todos los estudios. Esta variable demostró mayor poder predictivo para mortalidad que las extraídas de la realización de un test de oclusión vascular (AUROC 0.790, IC 95% 0.637-0.943, p=0.004). La presencia de rSO2 bajo al ingreso y tras 24horas de tratamiento fueron las únicas variables asociadas de forma independiente a mortalidad (HR 8.99, IC 95% 1.05-76.8, p=0,045 y HR 13.18, IC 95% 1.52-113.6, p=0.019, respectivamente). Conclusiones: la determinación del rSO2 puede ayudar a reconocer pacientes con sepsis de origen respiratorio de mayor gravedad de forma más temprana que otras variables hemodinámicas.
Introduction: community-acquired pneumonia is an alveolar infection. Despite progress it still represents an important cause of morbidity and mortality in the world. It is important to find a way to early detect the group of patients that presents worse prognostic. In this context, our investigation has evaluated tisular oxigenation as an indirect indicator of microcirculation’s state which can early detect patients at risk of presenting complications. Methods: we included patients admitted to the ICU with the diagnostic of community-acquired pneumonia. Measurements of regional oxygen saturation index (rSO2) were taken using near-infrared spectroscopy technology. The association between this variable and other classical hemodynamic variables and their predictive value for mortality were determined. Results: presence of low rSO2 value was associated with greater mortality. This variables showed better predictive power for mortality than the ones obtained with a vascular occlusion test (AUROC 0.790, IC 95% 0.637-0.943, p=0.004). The presence of low rSO2 at admission and 24 hours after were the only variables that were independently associated with mortality (HR 8.99, IC 95% 1.05-76.8, p=0,045 i HR 13.18, IC 95% 1.52-113.6, p=0.019, respectively). Conclusions: determination of rSO2 can identify which patients with respiratory sepsis present greater severity earlier than other hemodynamical variables.
Introduction: community-acquired pneumonia is an alveolar infection. Despite progress it still represents an important cause of morbidity and mortality in the world. It is important to find a way to early detect the group of patients that presents worse prognostic. In this context, our investigation has evaluated tisular oxigenation as an indirect indicator of microcirculation’s state which can early detect patients at risk of presenting complications. Methods: we included patients admitted to the ICU with the diagnostic of community-acquired pneumonia. Measurements of regional oxygen saturation index (rSO2) were taken using near-infrared spectroscopy technology. The association between this variable and other classical hemodynamic variables and their predictive value for mortality were determined. Results: presence of low rSO2 value was associated with greater mortality. This variables showed better predictive power for mortality than the ones obtained with a vascular occlusion test (AUROC 0.790, IC 95% 0.637-0.943, p=0.004). The presence of low rSO2 at admission and 24 hours after were the only variables that were independently associated with mortality (HR 8.99, IC 95% 1.05-76.8, p=0,045 i HR 13.18, IC 95% 1.52-113.6, p=0.019, respectively). Conclusions: determination of rSO2 can identify which patients with respiratory sepsis present greater severity earlier than other hemodynamical variables.