Correlación entre saturación venosa, ruptura de anastomosis y formación de fístulas en pacientes con trauma abdominal en el Hospital Occidente de Kennedy

Abstract

The management of abdominal trauma involves the challenge of performing intestinal anastomosis or suture in hemodynamically compromised patients. The decision of damage control surgery in the presence of acidosis, hypothermia and coagulopathy is evident, however the situation is not always so clear. In individuals with trauma develop molecular changes and inflammatory by improper balance between oxygen supply and demand that affect the process of tissue repair with the risk of fistula formation. A quick and convenient way to detect this hypoperfusion is measuring venous oxygen saturation (SvO2) and Serum Lactate.OBJECTIVES: To establish correlation between intraoperative SVO2 values and intestinal fistulae in patients undergoing surgery for abdominal trauma.

MATERIALS AND METHODS: This prospective cohort study analyzed different variables related to the occurrence of fistulas in patients with abdominal trauma requiring suturing in the gastrointestinal tract, emphasizing SVO2 levels.

RESULTS: Anastomotic failure patients presented a lower SVO2 average (60.0% ± 2.94%) versus non fistulized (69.89% ± 7.21%) (p = 0.010). All patients in the cohort exposed (SvO2 <65%), dehiscence of the anastomosis (RR = 39.8, 95% CI: 2.35,659.91, p <0.001, Fisher exact test). The positive predictive value of saturation (<65%) was 57.14% (95% CI: 13.34%, 100%) and negative predictive value was 100% (95% CI: 81.75%, 100%). The sensitivity was 100% (95% CI: 87.50%, 100%) and specificity of 91.89% (95% CI: 81.75%, 100%). In the bivariate analysis determined that the abdominal trauma index, hemoglobin level and the requirement for RBC transfusion, are risk factors directly related to the failure of the anastomosis in patients with abdominal trauma CONCLUSIONS: - There is a strong relationship between intestinal failure and repair SVO2 <65%. - The prognosis of intestinal anastomosis is directly related to hemodynamic status and tissue perfusion at the time of surgery. - The level of SVO2 can support the surgeon in the decision of whether or not a repair on viscera when surgical intervention in a patient with abdominal trauma.