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Asociación entre agua extra-vascular pulmonar con Sdra y mortalidad en pacientes adultos en choque circulatorio. Estudio de cohorte

dc.contributor.advisorMeléndez Flórez, Héctor Julio
dc.contributor.advisorNaranjo Junoy, Francisco Fernando
dc.contributor.authorSánchez Gálvez, Héctor Fabio
dc.coverage.spatialColombiaspa
dc.date.accessioned2021-08-26T16:30:14Z
dc.date.available2021-08-26T16:30:14Z
dc.date.issued2021
dc.identifier.urihttp://hdl.handle.net/20.500.12749/14031
dc.description.abstractLa identificación temprana del Síndrome de distress respiratorio agudo (SDRA) en pacientes con choque puede permitir estrategias protectoras oportunas. El agua extravascular pulmonar (EVLW) es un posible marcador de SDRA. No está claro si EVLW medida al inicio del choque identifica tempranamente los pacientes en riesgo de desarrollar SDRA o morir. Investigamos la asociación entre EVLW medida tempranamente con desarrollo de SDRA y mortali-dad. Objetivo: Determinar asociación entre agua extra-vascular pulmonar indexada a peso predicho (EVLWI) con SDRA y mortalidad en una cohorte de pacientes en choque. Materiales y Métodos: Estudio observacional, analítico tipo cohorte retrospectiva de 147 pacien-tes en estado de choque, ingresados a UCI de tercer nivel. El EVLW fue medida al ingreso a UCI e indexada al peso ideal (EVLWI). Sé estudió la asociación de este índice con desarrollo de SDRA y la mortalidad a 28 días. Se aplico análisis Bivariado y Multivariado así como un modelo de regresión logística para establecer la relación y fuerza de asociación entre EVLWI con SDRA y mortalidad ajustando por variables demográficas y clínicas. Se aplicó un modelo de riesgos proporcionales de Cox, donde la mortalidad en función del tiempo fue relacionada con variables independientes que fueron significativas. Resultados: Los pacientes que desarrollaron SDRA tenían valores mas altos de EVLWI, que los pacientes que no desarrollaron SDRA. (14.0 ml/kg Vs. 8.0 ml/kg respectivamente) (RR 2,66 IC 1,68 - 4,22) (p 0.00). No encontramos asociación entre EVLWI medida al inicio con mortalidad a los 28 días de egreso de la UCI (RR 1,17; IC: 0.88 - 1.56) (p 0.26). La mediana del tiempo de supervivencia general fue de 14 días (IC 95% 6,08 – 21,91). Conclusiones: El EVLWI se asoció con desarrollo de SDRA, pero no con mortalidad al día 28. Se requieren estudios prospectivos que comprueben esta asociación.spa
dc.description.tableofcontentsI. INTRODUCCION 9 II. PLANTEAMIENTO DEL PROBLEMA 10 III. PREGUNTAS DE INVESTIGACION 17 IV. HIPOTESIS DE TRABAJO 17 V. MARCO TEORICO Y ESTADO DEL ARTE 17 V.1. Síndrome de Distress Respiratorio Agudo 17 V.1.1. Etiología 19 V.1.2. Fisiopatologia 19 V.1.3. Tratamiento 21 a. Ventilación protectora pulmonar 21 b. Fluidoterapia 22 c. Ventilación mecánica en prono 22 V.2. Los estados de choque 23 V.2.1. Clasificación 24 V.3. Agua Extravascular Pulmonar 24 V.4. Termodilucion Transpulmonar 29 VI. JUSTIFICACION 30 VII. OBJETIVOS 30 VII.1. Objetivo General 30 VII.2. Objetivos específicos 30 VIII. METODOLOGIA 30 VIII.1.Tipo de estudio 30 VIII.2.Población a estudio 30 VIII.3. Tamaño de la muestra 31 VIII.4.Criterios de inclusión 31 VIII.5.Criterios de exclusión 31 VIII.6.Variables de estudio 32 VIII.7. Fuentes y ttécnicas de recolección de datos 32 VIII.8. Control de sesgos 33 IX. ASPECTOS ETICOS Y LEGALES 33 X. ANALISIS ESTADISTICO 35 X.1. Características generales o Análisis Univariado 35 X.2. Análisis comparativo o Bivariado 35 X.3. Análisis multivariado 35 X.4. Análisis de supervivencia regresion de Cox 35 XI. RESULTADOS 37 Características Generales 37 XI.1 Características generales y clinicas 37 XI.2. SDRA según EVLWI y variables clínicas 43 XI.3. Análisis de Mortalidad 44 XI.3. 1 Mortalidad, EVLWI y SDRA 44 XI.3. 2 Análisis entre Mortalidad, SDRA y EVLWI 45 XI.3. 3 Análisis de supervivencia a 28 días y regresión de Cox para mortalidad 46 XII. DISCUSION 50 XIII. CONCLUSIONES 56 XIV. DIVULGACION Y SOCIALIZACION 56 XV. ALCANCE DEL TRABAJO DE GRADO 56 XVI. BIBLIOGRAFÍA 57 XVII ANEXOS 62spa
dc.format.mimetypeapplication/pdfspa
dc.language.isospaspa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/*
dc.titleAsociación entre agua extra-vascular pulmonar con Sdra y mortalidad en pacientes adultos en choque circulatorio. Estudio de cohortespa
dc.title.translatedAssociation between pulmonary extra-vascular water with ARDS and mortality in adult patients in circulatory shock. Cohort studyspa
dc.degree.nameEspecialista en Medicina Crítica y Cuidado Intensivo del Adultospa
dc.publisher.grantorUniversidad Autónoma de Bucaramanga UNABspa
dc.rights.localAbierto (Texto Completo)spa
dc.publisher.facultyFacultad Ciencias de la Saludspa
dc.publisher.programEspecialización en Medicina Crítica y Cuidado Intensivo del Adultospa
dc.description.degreelevelEspecializaciónspa
dc.type.driverinfo:eu-repo/semantics/masterThesis
dc.type.localTesisspa
dc.type.coarhttp://purl.org/coar/resource_type/c_bdcc
dc.subject.keywordsMedical sciencesspa
dc.subject.keywordsHealth sciencesspa
dc.subject.keywordsCritical care medicinespa
dc.subject.keywordsPatient monitoringspa
dc.subject.keywordsExtravascular Lung Waterspa
dc.subject.keywordsAcute Respiratory Distress Syndromespa
dc.subject.keywordsThermodilutionspa
dc.subject.keywordsShortness of breathspa
dc.subject.keywordsLung diseasesspa
dc.subject.keywordsRespiratory insufficiencyspa
dc.identifier.instnameinstname:Universidad Autónoma de Bucaramanga - UNABspa
dc.identifier.reponamereponame:Repositorio Institucional UNABspa
dc.type.hasversioninfo:eu-repo/semantics/acceptedVersion
dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.accessrightshttp://purl.org/coar/access_right/c_abf2spa
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dc.contributor.cvlacNaranjo Junoy, Francisco Fernando [0000176095]spa
dc.contributor.cvlacMeléndez Flórez, Héctor Julio [0000320609]spa
dc.contributor.orcidNaranjo Junoy, Francisco Fernando [0000-0001-8628-8743]spa
dc.contributor.researchgateNaranjo Junoy, Francisco Fernando [Francisco-Naranjo-Junoy-2075424896]spa
dc.contributor.researchgateMeléndez Flórez, Héctor Julio [Hector-Florez-3]spa
dc.subject.lembCiencias médicasspa
dc.subject.lembCuidados intensivos (Medicina)spa
dc.subject.lembMonitoreo de pacientesspa
dc.subject.lembDificultad respiratoriaspa
dc.subject.lembEnfermedades de los pulmonesspa
dc.subject.lembInsuficiencia respiratoriaspa
dc.identifier.repourlrepourl:https://repository.unab.edu.cospa
dc.description.abstractenglishThe early identification of Acute Respiratory Distress Syndrome (ARDS) in patients with shock may allow timely protective strategies. Extravascular pulmonary water (EVLW) is a possible marker for ARDS. It is not clear whether EVLW measured at onset of shock identifies patients at risk of developing ARDS or dying early. We investigated the association between EVLW measured early with the development of ARDS and mortality. Objective: To determine the association between extra-vascular pulmonary water indexed to predicted weight (EVLWI) with ARDS and mortality in a cohort of patients in shock. Materials and Methods: Observational, analytical, retrospective cohort-type study of 147 patients in shock, admitted to third-level ICU. EVLW was measured at ICU admission and indexed to ideal weight (EVLWI). The association of this index with the development of ARDS and 28-day mortality was studied. Bivariate and multivariate analysis was applied, as well as a logistic regression model to establish the relationship and strength of association between EVLWI with ARDS and mortality, adjusting for demographic and clinical variables. A Cox proportional hazards model was applied, where mortality as a function of time was related to independent variables that were significant. Results: The patients who developed ARDS had higher EVLWI values ​​than the patients who did not develop ARDS. (14.0 ml / kg Vs. 8.0 ml / kg respectively) (RR 2.66 CI 1.68 - 4.22) (p 0.00). We found no association between EVLWI measured at baseline with mortality 28 days after discharge from the ICU (RR 1.17; CI: 0.88 - 1.56) (p 0.26). The median overall survival time was 14 days (95% CI 6.08-21.91). Conclusions: EVLWI was associated with the development of ARDS, but not with mortality at day 28. Prospective studies are required to verify this association.spa
dc.subject.proposalCiencias de la saludspa
dc.subject.proposalSíndrome de distrés respiratorio agudospa
dc.subject.proposalAgua pulmonar extravascularspa
dc.subject.proposalShockspa
dc.subject.proposalTermodilucionspa
dc.type.redcolhttp://purl.org/redcol/resource_type/TM
dc.rights.creativecommonsAtribución-NoComercial-SinDerivadas 2.5 Colombia*
dc.coverage.campusUNAB Campus Bucaramangaspa
dc.description.learningmodalityModalidad Presencialspa


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