Sobrecarga Hídrica en Postoperatorio de Cirugía Cardiaca Pediátrica
Digital
- Autores:
-
Ortiz Córdoba, Angélica Lucero
- Tipo de recurso:
- Trabajo de grado de pregrado
- Fecha de publicación:
- 2021
- Institución:
- Universidad de Santander
- Repositorio:
- Repositorio Universidad de Santander
- Idioma:
- spa
- OAI Identifier:
- oai:repositorio.udes.edu.co:001/5094
- Acceso en línea:
- https://repositorio.udes.edu.co/handle/001/5094
- Palabra clave:
- Sobrecarga hídrica
Unidad de Cuidado Intensivo
Cardiopatía congénita
Prevalencia
Incidencia
Fluid overload
Intensive Care Unit
Congenital heart disease
Prevalence
Incidence
- Rights
- openAccess
- License
- Derechos Reservados - Universidad de Santander, 2021
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Sobrecarga Hídrica en Postoperatorio de Cirugía Cardiaca Pediátrica |
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Sobrecarga Hídrica en Postoperatorio de Cirugía Cardiaca Pediátrica Sobrecarga hídrica Unidad de Cuidado Intensivo Cardiopatía congénita Prevalencia Incidencia Fluid overload Intensive Care Unit Congenital heart disease Prevalence Incidence |
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Sobrecarga Hídrica en Postoperatorio de Cirugía Cardiaca Pediátrica |
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Sobrecarga Hídrica en Postoperatorio de Cirugía Cardiaca Pediátrica |
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Sobrecarga Hídrica en Postoperatorio de Cirugía Cardiaca Pediátrica |
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Sobrecarga Hídrica en Postoperatorio de Cirugía Cardiaca Pediátrica |
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Sobrecarga Hídrica en Postoperatorio de Cirugía Cardiaca Pediátrica |
| dc.creator.fl_str_mv |
Ortiz Córdoba, Angélica Lucero |
| dc.contributor.advisor.none.fl_str_mv |
Rodríguez Orozco, Diana-Carolina Martínez Vega, Ruth Aralí |
| dc.contributor.author.none.fl_str_mv |
Ortiz Córdoba, Angélica Lucero |
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Sobrecarga hídrica Unidad de Cuidado Intensivo Cardiopatía congénita Prevalencia Incidencia |
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Sobrecarga hídrica Unidad de Cuidado Intensivo Cardiopatía congénita Prevalencia Incidencia Fluid overload Intensive Care Unit Congenital heart disease Prevalence Incidence |
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Fluid overload Intensive Care Unit Congenital heart disease Prevalence Incidence |
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Digital |
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2021 |
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2021-05-27T21:10:47Z |
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2021-05-27T21:10:47Z |
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2021-03-04 |
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Trabajo de grado - Especialización |
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Derechos Reservados - Universidad de Santander, 2021 |
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Atribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0) |
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Derechos Reservados - Universidad de Santander, 2021 Atribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0) https://creativecommons.org/licenses/by-nc-nd/4.0/ http://purl.org/coar/access_right/c_abf2 |
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117 p |
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Facultad Ciencias de la Salud |
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Bucaramanga, Colombia |
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Especialización en Cuidado Intensivo Pediátrico |
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Universidad de Santander |
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Rodríguez Orozco, Diana-Carolinaf9aca72a-6bde-407f-a430-6b6a75191e66-1Martínez Vega, Ruth Aralíaa92e0da-392f-46fd-886f-d56d43b46865-1Ortiz Córdoba, Angélica Lucero093616a1-bb50-485a-a8ef-3bc182e4dd9d-12021-05-27T21:10:47Z2021-05-27T21:10:47Z2021-03-04DigitalLa sobrecarga hídrica sigue siendo un factor determinante en el pronóstico postquirúrgico del paciente pese al progreso tanto de las técnicas quirúrgicas, como a la administración de esteroides para reducir la respuesta inflamatoria postcirculación extracorpórea, la restricción hídrica y el uso de diuréticos. En pacientes pediátricos sometidos a cirugía debido a cardiopatías congénitas, esto representa un evento preocupante puesto que se encuentra asociada a complicaciones postquirúrgicas como ventilación mecánica prolongada, mayor estancia en unidad de cuidado intensivo, lesión renal aguda y mortalidad. Debido al desconocimiento de la frecuencia de la sobrecarga hídrica en pacientes pediátricos durante el postoperatorio de la cirugía cardiaca en nuestra población, se hace imperativo identificar y caracterizar este evento. Esto con la finalidad de establecer modelos de atención asertivos y formular protocolos de investigación que evaluarían si la sobrecarga hídrica en nuestros pacientes plantea una problemática para la institución. Este es un estudio observacional, descriptivo, longitudinal y prospectivo, en el cual se han evaluado las historias clínicas de los pacientes de 0 a 5 años que contaban con un diagnóstico de cardiopatía congénita, y que hayan sido intervenidos quirúrgicamente sea de forma paliativa o correctiva en la Fundación Cardiovascular de Colombia entre el 1 de febrero del 2020 y el 31 de agosto del 2020. Este estudio evidenció que la sobrecarga hídrica en pacientes pediátricos intervenidos quirúrgicamente por cardiopatías congénitas, principalmente en cirugías correctivas, equivale a una prevalencia de 9% (IC95% 4,2% - 18,2%) y a una incidencia 3,3% (IC95% 0,9% -11,2%). Además, la sobrevida a los 30 días fue del 94%, con una mediana de 35 días de estancia hospitalaria. Evidenciándose que aquellos pacientes que desarrollaron sobrecarga hídrica durante las primeras 24 horas posteriores al procedimiento tuvieron tiempo con bomba prolongado, requirieron hemoderivados y/o tenían falla cardiaca previa. Mientras que los dos casos que presentaron sobrecarga hídrica una vez transcurridas 24 horas luego del procedimiento tenían factores como una prolongada nutrición parenteral, requerir terapia de remplazo renal o una larga estancia en UCI.Fluid overload continues to be a determining factor in the postoperative prognosis of the patient despite the progress of surgical techniques, the administration of steroids to reduce the inflammatory response after extracorporeal circulation, water restriction or use of diuretics. In pediatric patients undergoing surgery due to congenital heart disease, this represents a worrisome event since it is associated with postoperative complications such as prolonged mechanical ventilation, longer stay in the intensive care unit, acute kidney injury and mortality. Due to the lack of knowledge about the frequency of fluid overload in pediatric patients during the postoperative period of cardiac surgery in our population, it is imperative to identify and characterize this event; This in order to establish assertive care models and formulate research protocols that would assess whether fluid overload in our patients poses a problem for the institution. This is an observational, descriptive, longitudinal and prospective study, in which the medical records of patients aged 0 to 5 years who had a diagnosis of congenital heart disease, and who have undergone surgery either palliatively or correctively at the Cardiovascular Foundation of Colombia between the period of February 1, 2020 to August 31, 2020, have been evaluated. This study showed that fluid overload in pediatric patients undergoing surgery for congenital heart disease, mainly in corrective surgeries, is equivalent to a prevalence of 9% (95% CI 4.2% - 18.2%) and an incidence 3.3% (95% CI % 0.9% -11.2%), as well as the survival to 30 days was 94% with a median of 35 days of hospital stay. It was also evidenced that those patients who developed fluid overload during the first 24 hours after the procedure had a longer time on the pump, required blood products and/or had a previous heart failure. While the two cases that presented fluid overload after 24 hours after the procedure had factors such as prolonged parenteral nutrition, requiring renal replacement therapy or a long stay in the ICU.PregradoEspecialista en Cuidado Intensivo Pediátrico1 ed.1. INTRODUCCIÓN .................................................................................................. 1 2. PLANTEAMIENTO DEL PROBLEMA ................................................................... 3 2.1. Pregunta de investigación .......................................................................... 4 3. OBJETIVOS .......................................................................................................... 5 3.1. Objetivo general ......................................................................................... 5 3.2. Objetivos específicos ................................................................................. 5 4. MARCO REFERENCIAL ....................................................................................... 6 4.1. Manejo preoperatorio del paciente pediátrico con cardiopatía congénita .. 6 4.1.1. Epidemiología de las cardiopatías congénitas......................................... 6 4.1.2. Consideraciones generales. ..................................................................... 7 4.1.3. Valoración de riesgo. ................................................................................. 8 4.1.4. Efectos de los fármacos anestésicos en pacientes con cardiopatía congénita. ............................................................................................................... 8 4.1.5. Manejo hidroelectrolítico. ........................................................................ 12 4.1.6. Glicocálix endotelial. ................................................................................ 15 4.2. MANEJO INTRAOPERATORIO .............................................................. 21 4.2.1. Estado nutricional y ayuno. ..................................................................... 21 4.2.2. Bypass cardiopulmonar: fisiología y fisiopatología. ............................... 22 4.2.3. Uso de hemoderivados durante la cirugía cardiaca. ................................28 4.2.4. Hematocrito ideal. .................................................................................... 29 4.2.5. Ultrafiltración ............................................................................................ 30 4.3. MANEJO POSTOPERATORIO DE LA SOBRECARGA HÍDRICA .......... 32 4.4. ¿Cómo sucede la sobrecarga hídrica en la falla cardiaca? ..................... 38 4.5. Fases de reanimación hídrica .................................................................. 39 4.6. Cuantificación de la sobrecarga hídrica ................................................... 41 4.7. Opciones para el tratamiento de sobrecarga hídrica ............................... 43 5. METODOLOGÍA .................................................................................................. 47 5.1. Tipología de estudio................................................................................. 47 5.2. Unidad de estudio .................................................................................... 47 5.3. Criterios de inclusión y exclusión ............................................................. 47 5.3.1. Criterios de inclusión. .............................................................................. 47 5.3.2. Criterios de exclusión. ............................................................................. 48 5.4. Variables de estudio ................................................................................ 48 5.5. Recolección de datos............................................................................... 49 5.5.1. Instrumento usado para la recolección de la información. .................... 49 5.5.2. Procesamiento y análisis de datos. ........................................................ 49 5.5.3. Aspectos éticos. ...................................................................................... 50 6. RESULTADOS .................................................................................................... 52 6.1. Características prequirúrgicas ................................................................. 56 6.2. Características intraquirúrgicas ............................................................... 61 6.3. Características postquirúrgicas ................................................................ 66 6.4. Prevalencia e incidencia de la sobrecarga hídrica en la población de estudio ............................................................................................................... 72 6.4.1 Caracterización de los pacientes con sobrecarga hídrica prevalente. . 73 6.4.2 Caracterización de los pacientes con sobrecarga hídrica incidente. .... 80 7. DISCUSIÓN ........................................................................................................ 81 8. LIMITACIONES ................................................................................................... 89 9. CONCLUSIONES ................................................................................................ 90 10. RECOMENDACIONES ................................................................................ 92 11. BIBLIOGRAFÍA ............................................................................................ 93117 papplication/pdfT 78.21 O784shttps://repositorio.udes.edu.co/handle/001/5094spaFacultad Ciencias de la SaludBucaramanga, ColombiaEspecialización en Cuidado Intensivo PediátricoDerechos Reservados - Universidad de Santander, 2021info:eu-repo/semantics/openAccessAtribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0)https://creativecommons.org/licenses/by-nc-nd/4.0/http://purl.org/coar/access_right/c_abf2Sobrecarga hídricaUnidad de Cuidado IntensivoCardiopatía congénitaPrevalenciaIncidenciaFluid overloadIntensive Care UnitCongenital heart diseasePrevalenceIncidenceSobrecarga Hídrica en Postoperatorio de Cirugía Cardiaca PediátricaTrabajo de grado - Especializaciónhttp://purl.org/coar/resource_type/c_7a1fTextinfo:eu-repo/semantics/bachelorThesishttps://purl.org/redcol/resource_type/TPinfo:eu-repo/semantics/drafthttp://purl.org/coar/version/c_b1a7d7d4d402bcceTodas las AudienciasSandoval N. Congenital heart disease in Colombia and worldwide. Rev Colomb Cardiol [Internet]. 2015;22(1):1–2. Available from: http://dx.doi.org/10.1016/j.rccar.2015.03.004Hazle MA, Gajarski RJ, Yu S, Donohue J, Blatt NB. Fluid overload in infants following congenital heart surgery. Pediatr Crit Care Med. 2013;14(1):44–9.Boschee ED, Cave DA, Garros D, Lequier L, Granoski DA, Guerra GG, et al. Indications and outcomes in children receiving renal replacement therapy in pediatric intensive care. J Crit Care [Internet]. 2014;29(1):37–42. Available from: http://dx.doi.org/10.1016/j.jcrc.2013.09.008Gillespie M, Kuijpers M, Van Rossem M, Ravishankar C, Gaynor JW, Spray T, et al. Determinants of intensive care unit length of stay for infants undergoing cardiac surgery. Congenit Heart Dis. 2006;1(4):152–60.Nicholson GT, Clabby ML, Mahle WT. Is there a benefit to postoperative fluid restriction following infant surgery? 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Contin Educ Anaesthesia, Crit Care Pain. 2012;12(1):23–7.Friesen RH. Anesthetic drugs in congenital heart disease. Semin Cardiothorac Vasc Anesth. 2014;18(4):363–70.Williams GD, Sa FFA, Jones TK, Morray JP, Hanson KA. Ane Analg-1999-89(6)- 1411(Hemodynamic effect of propofol in CHD).pdf. 1999;Loomba RS, Gray SB, Flores S. Hemodynamic effects of ketamine in children with congenital heart disease and/or pulmonary hypertension. Congenit Heart Dis. 2018;13(5):646–54.D WESM. therapy. 1995;(1957):1995.Zieg J. Pathophysiology of hyponatremia in children. Front Pediatr. 2017;5(October).Johns EJ, Kopp UC, DiBona GF. Neural control of renal function. Compr Physiol. 2011;1(2):731–67.Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014;170(3).Reitsma S, Slaaf DW, Vink H, Van Zandvoort MAMJ, Oude Egbrink MGA. The endothelial glycocalyx: Composition, functions, and visualization. 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Br J Anaesth. 2018;120(3):469–74.Hirleman E, Larson DF. Cardiopulmonary bypass and edema: Physiology and pathophysiology. Perfusion. 2008;23(6):311–22.Stiller B, Sonntag J, Dähnert I, Alexi-Meskishvili V, Hetzer R, Fischer T, et al. Capillary leak syndrome in children who undergo cardiopulmonary bypass: Clinical outcome in comparison with complement activation and C1 inhibitor. Intensive Care Med. 2001;27(1):193–200.Mastropietro CW, Valentine KM. Pediatric critical care: Current controversies. Pediatric Critical Care: Current Controversies. 2018. 1–350 p.Durandy Y. Use of blood products in pediatric cardiac surgery. Artif Organs. 2015;39(1):21–7.Shander A, Fink A, Javidroozi M, Erhard J, Farmer SL, Corwin H, et al. Appropriateness of allogeneic red blood cell transfusion: The international consensus conference on transfusion outcomes. Transfus Med Rev [Internet]. 2011;25(3):232-246.e53.Morris KP, Naqvi N, Davies P, Smith M, Lee PW. A new formula for blood transfusion volume in the critically ill. Arch Dis Child. 2005;90(7):724–8.Ziyaeifard M, Alizadehasl A, Massoumi G. Modified ultrafiltration during cardiopulmonary bypass and postoperative course of pediatric cardiac surgery. Res Cardiovasc Med. 2014;3(2):5.José Curi-Curi P, Aguilar Alanis E, Calderón- Colmenero J, Luis Cervantes-Salazar J, Reyes Pavón R, Ramírez-Marroquín S. Impact of Modified Ultrafiltration in Congenital Heart Disease Patients Treated with Cardiopulmonary Bypass. Congenit Heart Dis. 2018;Davies MJ, Nguyen K, Gaynor JW, Elliott MJ, De Leval MR, Penkoske PA, et al. Modified ultrafiltration improves left ventricular systolic function in infants after cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1998;115(2):361–70.Ootaki Y, Yamaguchi M, Oshima Y, Yoshimura N, Oka S. Effects of modified ultrafiltration on coagulation factors in pediatric cardiac surgery. Surg Today. 2002;32(3):203–6.Claure-Del Granado R, Mehta RL. Fluid overload in the ICU: evaluation and management. BMC Nephrol [Internet]. 2016;17(1):109. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27484681Chakko S, Woska D, Martinez H, Marchena E De, Futterman L, Kessler KM, et al. Clinical, radiographic, and hemodynamic correlations in chronic congestive heart failure: Conflicting results may lead to inappropriate care. Am J Med. 1991;90(1):353–9.Peacock WF, Soto KM. Current techniques of fluid status assessment. Contrib Nephrol. 2010;164:128–42.Katzarski KS, Nisell J, Randmaa I, Danielsson A, Freyschuss U, Bergström J. A critical evaluation of ultrasound measurement of inferior vena cava diameter in assessing dry weight in normotensive and hypertensive hemodialysis patients. Am J Kidney Dis. 1997;30(4):459–65.Ronco C, Cicoira M, McCullough PA. Cardiorenal syndrome type 1: Pathophysiological crosstalk leading to combined heart and kidney dysfunction in the setting of acutely decompensated heart failure. J Am Coll Cardiol [Internet]. 2012;60(12):1031–42. Available from: http://dx.doi.org/10.1016/j.jacc.2012.01.077Lullo L Di, Reeves PB, Bellasi A, Ronco C. Cardiorenal Syndrome in Acute Kidney Injury. Semin Nephrol [Internet]. 2019;39(1):31–40. Available from: https://doi.org/10.1016/j.semnephrol.2018.10.003Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal Syndrome. J Am Coll Cardiol. 2008;52(19):1527–39.Hoste EA, Maitland K, Brudney CS, Mehta R, Vincent JL, Yates D, et al. Four phases of intravenous fluid therapy: A conceptual model. Br J Anaesth. 2014;113(5):740–7.Goldstein SL, Currier H, Graf JM, Cosio CC, Brewer ED, Sachdeva R. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics. 2001;107(6):1309–12.Arikan AA, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. 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