VARIACIÓN DE LA PRESIÓN DE PULSO DURANTE LA VENTILACIÓN MECÁNICA COMO PREDICTOR DE HIPOVOLEMIA EN EL PACIENTE SÉPTICO EN LA UNIDAD DE CUIDADOS INTENSIVOS DEL HOSPITAL IESS TEODORO MALDONADO CARBO DE GUAYAQUIL 2015-2016

Abstract

Pulse rate variability (PPV) is a parameter that not only indicates the condition of the intravascular volume of the patient, but also predicts the response after fluid administration; The aim of our study was to compare the percentage values of the Pulmonary Pressure (PPV) variation with the traditional hemodynamic parameters: central venous pressure, mean arterial pressure and heart rate (PVC-TAM-FC); As predictors of hypovolemia in the septic patient in mechanical ventilation. The method used for the study was observational, which included patients diagnosed with septic shock in mechanical ventilation, monitored through an arterial catheter connected to the floc-trac system; The study excluded patients with mitral valvulopathy, arrhythmias and chronic obstructive pulmonary disease. The results obtained from July 2015 to December 2016 were collected from a total of 342 clinical records of patients admitted to the Intensive Care Unit; But only 70 patients met the inclusion criteria, 51% were male and 49% female, mean age 50 ± 5, SOFA scale with one or two organ dysfunctions; Whose time of clinical evolution was> 8 hours in 54%; Fluid refractory hypovolemia was 21% associated with a 71% mortality; Levels of variation of pulse pressure> 12% and central venous pressure (PVC) <8cmH20 were compared within the first hours of evolution; Blood pressure was compared between the range of 66 to 70 mmHg with PPV levels between 9-12%; The comparison between cardiac index and PPV was 17 cases between the ranges of <2.8 (l / min / m2) and <12% for PPV. The range of <8mmHg of PVC and> 12% of VPP was used as a resuscitation measure to reanimate patients in shock. We recommend prospective studies comparing the variation of pulse pressure with other more sensitive and specific measures to determine the patient's volemia status, such as measuring the degree of distension of the vena cava, pulmonary artery catheter, in order to know the role Diagnosis of hypovolemia in ventilated septic patients.