masterThesis
Diferencia venoarterial de PCO2 como predictor de disfunción miocárdica en niños con sepsis severa y choque séptico
Fecha
2017Autor
Rodríguez Suesca, María Angélica
Erazo, Ana María
Orozco, Rafael
Gualdron, Nathalie
Institución
Resumen
Backround: Sepsis is one of the main causes of morbidity and mortality in pediatrics, and the myocardial dysfunction worsens the prognosis. Objective: To determine the concordance between the veno-arterial difference of CO2 (Pv-aCO2) and myocardial dysfunction in children with severe sepsis and septic shock. Materials and methods: Prospective observational study with concordance analysis. Simultaneously an echocardiogram, arterial and venous gases were performed in each patient, to measure the venoarterial difference of pCO2, to asses the concordance between an ejection fraction of less than 60% and a Pv-aCO2 greater than 5 mmHg in children hospitalized in Pediatric Intensive Care of the Cardioinfantil Foundation. Results: Half of the patients were younger than 24 months with a predominance of males (53.7%). The main infectious focus was pulmonary in 56% of cases (survival of 91.2%). The patients who died presented higher value of the venous lactate (RIC 16.233.6 p= 0.02). No concordance was found between myocardial dysfunction (by echocardiography) and a Pv-aCO2 greater than 5mmHg, in children with severe sepsis and septic shock, kappa value 0.28 (p = 0.38), but in children with normal central venous saturation a Pv-aCO2 greater than 5mmHg, there was a significative concordance kappa value 0.89 (p <0.001) in a bidimensional analysis. Conclusions: The CO2 delta is not associated with the presence of myocardial dysfunction in children with severe sepsis and septic shock but the central venous saturation normal values with an altered CO2 delta showed a significative concordance with myocardial dysfunction and may be useful as a complement in these cases.