Mortalidad en paciente oncológico crítico en cuidado intensivo

En los últimos 20 años varios avances realizados en cuanto al diagnóstico precoz y tratamiento agresivo de los pacientes oncológicos, han derivado en la disminución de la mortalidad global en un 20%; la mejora en el tratamiento del cáncer se traduce en un aumento del número de pacientes que no se cu...

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Autores:
Peralta Álvarez, Lilia Marcela
Serrano Báez, Gustavo Adolfo
Tipo de recurso:
Fecha de publicación:
2018
Institución:
Universidad Autónoma de Bucaramanga - UNAB
Repositorio:
Repositorio UNAB
Idioma:
spa
OAI Identifier:
oai:repository.unab.edu.co:20.500.12749/1724
Acceso en línea:
http://hdl.handle.net/20.500.12749/1724
Palabra clave:
Intensive care
Medicine
Emergency medicine
Oncology
Critical medicine
Intensive adult care
Investigations
Relationship with patients
Early treatment
Health care
Critical cancer patients
Cuidados intensivos
Medicina
Medicina de urgencias
Oncología
Medicina crítica
Cuidado intensivo del adulto
Investigaciones
Relación con los pacientes
Tratamiento precoz
Atención en salud
Pacientes oncológicos críticos
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openAccess
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http://creativecommons.org/licenses/by-nc-nd/2.5/co/
id UNAB2_a518013a53014804cc59c40e43839f80
oai_identifier_str oai:repository.unab.edu.co:20.500.12749/1724
network_acronym_str UNAB2
network_name_str Repositorio UNAB
repository_id_str
dc.title.spa.fl_str_mv Mortalidad en paciente oncológico crítico en cuidado intensivo
dc.title.translated.eng.fl_str_mv Mortality in a critical cancer patient in intensive care
title Mortalidad en paciente oncológico crítico en cuidado intensivo
spellingShingle Mortalidad en paciente oncológico crítico en cuidado intensivo
Intensive care
Medicine
Emergency medicine
Oncology
Critical medicine
Intensive adult care
Investigations
Relationship with patients
Early treatment
Health care
Critical cancer patients
Cuidados intensivos
Medicina
Medicina de urgencias
Oncología
Medicina crítica
Cuidado intensivo del adulto
Investigaciones
Relación con los pacientes
Tratamiento precoz
Atención en salud
Pacientes oncológicos críticos
title_short Mortalidad en paciente oncológico crítico en cuidado intensivo
title_full Mortalidad en paciente oncológico crítico en cuidado intensivo
title_fullStr Mortalidad en paciente oncológico crítico en cuidado intensivo
title_full_unstemmed Mortalidad en paciente oncológico crítico en cuidado intensivo
title_sort Mortalidad en paciente oncológico crítico en cuidado intensivo
dc.creator.fl_str_mv Peralta Álvarez, Lilia Marcela
Serrano Báez, Gustavo Adolfo
dc.contributor.advisor.spa.fl_str_mv Naranjo Junoy, Francisco Fernando
Meléndez Flórez, Héctor Julio
dc.contributor.author.spa.fl_str_mv Peralta Álvarez, Lilia Marcela
Serrano Báez, Gustavo Adolfo
dc.contributor.cvlac.*.fl_str_mv https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000176095
https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000320609
dc.contributor.orcid.*.fl_str_mv https://orcid.org/0000-0003-1791-8099
dc.subject.keywords.eng.fl_str_mv Intensive care
Medicine
Emergency medicine
Oncology
Critical medicine
Intensive adult care
Investigations
Relationship with patients
Early treatment
Health care
Critical cancer patients
topic Intensive care
Medicine
Emergency medicine
Oncology
Critical medicine
Intensive adult care
Investigations
Relationship with patients
Early treatment
Health care
Critical cancer patients
Cuidados intensivos
Medicina
Medicina de urgencias
Oncología
Medicina crítica
Cuidado intensivo del adulto
Investigaciones
Relación con los pacientes
Tratamiento precoz
Atención en salud
Pacientes oncológicos críticos
dc.subject.lemb.spa.fl_str_mv Cuidados intensivos
Medicina
Medicina de urgencias
Oncología
Medicina crítica
Cuidado intensivo del adulto
Investigaciones
Relación con los pacientes
dc.subject.proposal.none.fl_str_mv Tratamiento precoz
Atención en salud
Pacientes oncológicos críticos
description En los últimos 20 años varios avances realizados en cuanto al diagnóstico precoz y tratamiento agresivo de los pacientes oncológicos, han derivado en la disminución de la mortalidad global en un 20%; la mejora en el tratamiento del cáncer se traduce en un aumento del número de pacientes que no se curan pero que viven con esta patología. Debido a que se prevé que el número de pacientes que viven con cáncer aumentará en los próximos años, se deduce que también aumentará la demanda de pacientes que requieren tratamiento en la Unidad de Cuidado Intensivo (UCI), ya sea por complicaciones relacionadas con la neoplasia per sé o por los efectos secundarios derivados del tratamiento. La decisión de ingresar a estos pacientes en la UCI presenta, muchas veces, dilemas de tipo éticos, religiosos, administrativos, familiares y hasta de tipo médico, por lo que es preciso conocer muy bien el pronóstico y evolución de la neoplasia en estos pacientes. El hecho de que en múltiples estudios observacionales la mortalidad de los pacientes oncológicos en la UCI sea comparable a la de pacientes no oncológicos, es relevante y trascendente dado que podría modificar un ―paradigma‖ de conducta y decisión ante un paciente oncológico que requiera un tratamiento intensivo. Así, consideramos que el objetivo del ingreso de un paciente oncológico a una unidad de terapia intensiva es mejorar su expectativa vital, sin que las medidas que se adopten impliquen una disminución significativa de su calidad de vida tras el alta hospitalaria. Este último condicionante ha sido y sigue siendo un argumento utilizado en muchos centros para no ingresar a un paciente onco-hematológico en UCI, el cual tiene débil evidencia científica; por lo tanto los avances en la comprensión de la fisiopatología de ciertas complicaciones que se desarrollan en pacientes críticamente enfermos con tumores malignos, ha dado lugar a un tratamiento eficaz lo que a su vez se traduce en aumento de la supervivencia, por lo tanto en la UCI una resucitación adecuada y precoz sin limitaciones iniciales a técnicas de soporte vital ha demostrado disminuir también la mortalidad de este grupo de pacientes.
publishDate 2018
dc.date.issued.none.fl_str_mv 2018
dc.date.accessioned.none.fl_str_mv 2020-06-26T19:59:27Z
dc.date.available.none.fl_str_mv 2020-06-26T19:59:27Z
dc.type.driver.none.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.local.spa.fl_str_mv Tesis
dc.type.redcol.none.fl_str_mv http://purl.org/redcol/resource_type/TM
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/20.500.12749/1724
dc.identifier.instname.spa.fl_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional UNAB
url http://hdl.handle.net/20.500.12749/1724
identifier_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
reponame:Repositorio Institucional UNAB
dc.language.iso.spa.fl_str_mv spa
language spa
dc.relation.references.spa.fl_str_mv Peralta Álvarez, Lilia Marcela, Serrano Báez, Gustavo Adolfo (2018). Mortalidad en paciente oncológico crítico en cuidado intensivo. Bucaramanga (Santander, Colombia) : Universidad Autónoma de Bucaramanga UNAB
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spelling Naranjo Junoy, Francisco FernandoMeléndez Flórez, Héctor JulioPeralta Álvarez, Lilia MarcelaSerrano Báez, Gustavo Adolfohttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000176095https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000320609https://orcid.org/0000-0003-1791-80992020-06-26T19:59:27Z2020-06-26T19:59:27Z2018http://hdl.handle.net/20.500.12749/1724instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABEn los últimos 20 años varios avances realizados en cuanto al diagnóstico precoz y tratamiento agresivo de los pacientes oncológicos, han derivado en la disminución de la mortalidad global en un 20%; la mejora en el tratamiento del cáncer se traduce en un aumento del número de pacientes que no se curan pero que viven con esta patología. Debido a que se prevé que el número de pacientes que viven con cáncer aumentará en los próximos años, se deduce que también aumentará la demanda de pacientes que requieren tratamiento en la Unidad de Cuidado Intensivo (UCI), ya sea por complicaciones relacionadas con la neoplasia per sé o por los efectos secundarios derivados del tratamiento. La decisión de ingresar a estos pacientes en la UCI presenta, muchas veces, dilemas de tipo éticos, religiosos, administrativos, familiares y hasta de tipo médico, por lo que es preciso conocer muy bien el pronóstico y evolución de la neoplasia en estos pacientes. El hecho de que en múltiples estudios observacionales la mortalidad de los pacientes oncológicos en la UCI sea comparable a la de pacientes no oncológicos, es relevante y trascendente dado que podría modificar un ―paradigma‖ de conducta y decisión ante un paciente oncológico que requiera un tratamiento intensivo. Así, consideramos que el objetivo del ingreso de un paciente oncológico a una unidad de terapia intensiva es mejorar su expectativa vital, sin que las medidas que se adopten impliquen una disminución significativa de su calidad de vida tras el alta hospitalaria. Este último condicionante ha sido y sigue siendo un argumento utilizado en muchos centros para no ingresar a un paciente onco-hematológico en UCI, el cual tiene débil evidencia científica; por lo tanto los avances en la comprensión de la fisiopatología de ciertas complicaciones que se desarrollan en pacientes críticamente enfermos con tumores malignos, ha dado lugar a un tratamiento eficaz lo que a su vez se traduce en aumento de la supervivencia, por lo tanto en la UCI una resucitación adecuada y precoz sin limitaciones iniciales a técnicas de soporte vital ha demostrado disminuir también la mortalidad de este grupo de pacientes.1. Introducción 8 2. Planteamiento del problema 9 3. Marco teórico y estado del arte 12 3.1. Datos y cifras globales cáncer 13 3.2. Perspectivas históricas del Cáncer y la Unidad de Cuidado Intensivo 13 3.3. Mejora del pronóstico de cáncer de pacientes en la UCI 15 3.4. Ingreso en la UCI y políticas de restricción de los pacientes con cáncer 18 3.5. Indicaciones de ingreso en la UCI de los pacientes con cáncer 24 3.6. Predictores de mortalidad en pacientes oncologicos criticos 30 3.7. Manejo del paciente en estado crítico con cáncer en UCI 32 4. Objetivos e hipótesis 36 4.1. Pregunta de investigación 37 4.2. Hipótesis 37 4.3. Objetivos 37 5. Metodología 38 5.1. Tipo de estudio 38 5.2. Población 38 5.3. Muestra 38 5.4. Criterios de selección 38 5.5. Variables del estudio 38 5.6. Recolección de información 39 5.7. Construcción de la base de datos 39 5.8. Plan de análisis 39 5.9. Aspectos éticos 40 5.10. Alcances esperados 40 5.11. Cronograma de actividades 41 5.12. Presupuesto 41 6. Resultados 43 6.1. Selección de muestra 43 6.2. Datos sociodemográficos 43 6.3. Caracterización del cáncer al ingreso a UCI 46 6.4. Distribución según la clasificación de severidad de enfermedad, APACHE IV (Score Acute Physiology and Chronic Health Evaluation, por sus siglas en inglés) ............................................................................................................................................ 50 6.5. Prioridad de ingreso a UCI ............................................................................................. 51 6.6. Días de estancia promedio en UCI 52 6.7. Mortalidad en pacientes con cáncer ingresados a UCI 53 6.8. Mortalidad según los antecedentes personales en UCI 53 6.9. Mortalidad según las indicaciones de ingreso a la UCI 55 7. Discusión 57 8. Conclusiones 64 9. Bibliografía 65 10. ANEXOS 81 10.1. Anexo 1: Operacionalización de las variables 81 10.2. Anexo 2: Instrumento de recolección de información 84 10.3. Anexo 3: Escala de clasificación de APACHE IV 85EspecializaciónIn the last 20 years, several advances made in the early diagnosis and aggressive treatment of cancer patients have resulted in a 20% reduction in global mortality; the improvement in cancer treatment translates into an increase in the number of patients who are not cured but who live with this pathology. Since the number of patients living with cancer is expected to increase in the coming years, it follows that the demand for patients requiring treatment in the Intensive Care Unit (ICU) will also increase, either due to complications related to neoplasia. per se or due to the side effects derived from the treatment. The decision to admit these patients to the ICU often presents ethical, religious, administrative, family and even medical dilemmas, so it is necessary to know very well the prognosis and evolution of the neoplasia in these patients. The fact that in multiple observational studies the mortality of cancer patients in the ICU is comparable to that of non-cancer patients is relevant and transcendent since it could modify a ―paradigm‖ of conduct and decision when faced with an oncology patient who requires treatment. intensive. Thus, we consider that the objective of admission of an oncology patient to an intensive care unit is to improve their life expectancy, without the measures adopted implying a significant decrease in their quality of life after hospital discharge. This last conditioner has been and continues to be an argument used in many centers for not admitting an onco-hematological patient to the ICU, which has weak scientific evidence; Therefore, advances in the understanding of the pathophysiology of certain complications that develop in critically ill patients with malignant tumors, has led to effective treatment, which in turn translates into increased survival, therefore in the Adequate and early ICU resuscitation without initial limitations to life support techniques has also been shown to decrease mortality in this group of patients.application/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Atribución-NoComercial-SinDerivadas 2.5 ColombiaMortalidad en paciente oncológico crítico en cuidado intensivoMortality in a critical cancer patient in intensive careEspecialista en Medicina Crítica y Cuidado Intensivo del AdultoBucaramanga (Santander, Colombia)Universidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludEspecialización en Medicina Crítica y Cuidado Intensivo del Adultoinfo:eu-repo/semantics/masterThesisTesishttp://purl.org/redcol/resource_type/TMIntensive careMedicineEmergency medicineOncologyCritical medicineIntensive adult careInvestigationsRelationship with patientsEarly treatmentHealth careCritical cancer patientsCuidados intensivosMedicinaMedicina de urgenciasOncologíaMedicina críticaCuidado intensivo del adultoInvestigacionesRelación con los pacientesTratamiento precozAtención en saludPacientes oncológicos críticosPeralta Álvarez, Lilia Marcela, Serrano Báez, Gustavo Adolfo (2018). 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