masterThesis
Cambios observados en las variables clínicas y paraclínicas en las primeras 48 horas de hospitalización en la Unidad de Cuidados Intensivos de pacientes con neumonía severa adquirida en la comunidad y su relación con la mortalidad
Fecha
2012Autor
Beltrán Rodríguez, Johnny Adalber
Reyes Cortes, Oscar Ivan
Institución
Resumen
The prognosis of Community Acquired Pneumonia Severe (NAC-S) depends on treatment decisions put in place early. The physiological changes that occurred in the early hours can be difficult to detect. There is no model for determining early success of the therapy introduced in NAC-S. Methodology: Description of all patients hospitalized with CAP-S in the Intensive Care Unit Cardioinfantil Foundation between 2008 and 2012 making comparisons between groups (vs dead. Survivors) and between times (0, 24 and 48 hours from admission to the ICU) and performing binary logistic regression. Results: Among the patients who died the need for vasoactive support was higher at all time points evaluated (sig = 0.001) at baseline had higher requirements fractional inspired O2 (median 0.55% vs. 0.50%, sig = 0011), at 24 hours had pH (median 7345 vs.7.370, sig = 0.025) and diastolic blood pressure (median 58.5mmHg vs.61.0mmHg, sig = 0.049) lower, and 48 hours glycemia (median vs. 157mg/dL .142mg/dL, sig = 0.026) creatinine (median 1.1mg/dL vs.0.7mg/dL, sig = 0.062) and urea nitrogen (median vs. 35mg/dL. 22mg/dL, sig = 0.003) higher compared to patients who survived. Among the surviving patients had a decrease in heart rate between 0 and 24 hours (median 97lpm vs. 86lpm, sig = 0.000) and between 0 and 48 hours (median 97lpm vs. 81lpm, sig = 0.000) and a decrease of neutrophils between 0 and 48 hours (median vs 9838. 8617, sig = 0.062). Conclusions: Our findings suggest the existence of a sequence of pathophysiological phenomena to be recognized early and clearly allow for a more specific plan and effective resuscitation. These differences may arise in the context of a mixed model predictive