Monitoreo en la UCI del Ion Cloro en el postquirúrgico en pacientes en recuperación de cirugía cardiovascular
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Fecha
2021
Autores
Bello Rosales, Luis Daniel
Merlano Cuello, Pedro Manuel
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
Introducción: Se ha demostrado que los pacientes críticos hospitalizados en unidades de cuidado intensivo suelen desencadenar hipercloremia, por lo que se ha motivado el estudio de la correlación entre este ion y la mortalidad en pacientes sépticos de las UCIs, de hecho, es posible afirmar que, al ingresar a la UCI, los pacientes con niveles más altos de Cl y el empeoramiento de la hipercloremia tras 72 horas de estancia en la unidad tienen gran relación con la mortalidad.
Metodología: Se realizó un estudio observacional con 177 pacientes postquirúrgicos cardiovasculares de los procedimientos (Revascularización miocárdica (bypass coronario), Remplazo valvular (mitral o aórtico) y Procedimientos mixtos (bypass + remplazo valvular)). Se realizaron comparaciones de la proporción de sexo, intervención, requerimiento de vasopresor, comorbilidades y presencia de lesión fenal aguda requerimientos de reintervención, así como la estancia en UCI y la mortalidad.
Resultados: el 26.7% fueron hombres. Edad global de 66±9 años, HTA fue la comorbilidad de mayor frecuencia (88.6%), creatinina sérica promedio preoperatorio de 1.0±0.29, 26% de los pacientes presentaron valores de hipercloremia 24hrs antes de la operación (111.8±2.29), cuyo valor se elevó a un 66.5% 24hrs después de la Operación (112.46±3.97) y 57.9% presentaron hipercloremia (118.81±2.9) posterior a 48 hrs.
Conclusión: Se evidenció un aumento preoperatorio de la creatinina sérica. La hipercloremia se mantuvo antes y después de la intervención quirúrgica. Se encontró una diferencia significativa en cuanto a los tiempos en los cuales se tomó los controles
Introduction: It has been shown that critical patients hospitalized in intensive care units usually trigger hyperchloremia. This has motivated the study of the correlation between this ion and mortality in septic patients in ICUs; in fact, it is possible to state that, upon admission to the ICU, patients with higher levels of Cl and the worsening of hyperchloremia after 72 hours of stay in the unit have a strong relationship with mortality. Methodology: An observational study was carried out with 177 post-surgical cardiovascular patients of the procedures (Myocardial revascularization (coronary bypass), Valve replacement (mitral or aortic) and Mixed procedures (bypass + valve replacement)). Comparisons were made of the proportion of sex, intervention, vasopressor requirement, comorbidities, and the presence of acute kidney injury, reoperation requirements, as well as ICU stay and mortality. Results: 26.7% were men. Global age of 66±9 years, ETS was the most frequent comorbidity (88.6%), preoperative serum creatinine average of 1.0±0.29, 26% of patients presented hyperchloremia values 24hrs before the operation (111.8±2.29), whose value rose to 66.5% 24hrs after the operation (112.46±3.97) and 57.9% presented hyperchloremia (118.81±2.9) after 48 hrs. Conclusion: A preoperative increase of serum creatinine was evidenced. Hyperchloremia remained before and after surgery. A significant difference was found in the times in which controls were taken
Introduction: It has been shown that critical patients hospitalized in intensive care units usually trigger hyperchloremia. This has motivated the study of the correlation between this ion and mortality in septic patients in ICUs; in fact, it is possible to state that, upon admission to the ICU, patients with higher levels of Cl and the worsening of hyperchloremia after 72 hours of stay in the unit have a strong relationship with mortality. Methodology: An observational study was carried out with 177 post-surgical cardiovascular patients of the procedures (Myocardial revascularization (coronary bypass), Valve replacement (mitral or aortic) and Mixed procedures (bypass + valve replacement)). Comparisons were made of the proportion of sex, intervention, vasopressor requirement, comorbidities, and the presence of acute kidney injury, reoperation requirements, as well as ICU stay and mortality. Results: 26.7% were men. Global age of 66±9 years, ETS was the most frequent comorbidity (88.6%), preoperative serum creatinine average of 1.0±0.29, 26% of patients presented hyperchloremia values 24hrs before the operation (111.8±2.29), whose value rose to 66.5% 24hrs after the operation (112.46±3.97) and 57.9% presented hyperchloremia (118.81±2.9) after 48 hrs. Conclusion: A preoperative increase of serum creatinine was evidenced. Hyperchloremia remained before and after surgery. A significant difference was found in the times in which controls were taken
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Palabras clave
Hipercloremia postoperatoria, Hipercloremia en UCI, Acidosis metabólica hiperclorémica, Postoperative hyperchloremia, UCI hyperchloremia, Hyperchloremic metabolic acidosis