Cambios en el pH sanguíneo en los pacientes críticos durante la hospitalización en Cuidados Intensivos / Changes in blood pH in critical patients during Hospitalization in Care Intensive

Objetivo: Determinar los cambios que se desarrollan en el pH sanguíneo de pacientes críticos en Cuidados Intensivos, según el tipo de trastorno. Diseño: Estudio cuantitativo, de observación, analítico, de tipo cohorte retrospectivo. Ámbito: Unidad de Cuidados Intensivos polivalente. Participantes, intervenciones y variables: 753 pacientes con pH normal, después de excluir a aquellos con registros insuficientes o antecedente de acidosis tubular renal. Se analizó la información de la base de datos clínica durante 21 meses. Mediante un análisis de supervivencia, se observó el cambio del pH, estratificando grupos de acuerdo con la alteración primaria y, luego, por morbilidad de ingreso. Se estimó la diferencia entre los grupos mediante la prueba del rango logarítmico. Los factores determinantes de acidemia metabólica se evaluaron mediante regresión de Cox. Resultados: Se evaluó a 753 pacientes (mediana de la edad 60 años [RIQ: 40- 71]). La mediana de estancia fue de 8 días (RIQ: 6-13). El 42% tenía alteración del pH. Predominó la acidemia, con más frecuencia en pacientes sépticos. La causa principal de acidemia parece ser la hipoperfusión. El desenlace es similar en pacientes alcalémicos. Conclusiones: Durante la estancia en la UCI, es frecuente el cambio del pH con igual proporción de acidemia y alcalemia. La mortalidad fue similar en pacientes con ambos trastornos. En pacientes acidémicos, la hipoperfusión parece ser el factor desencadenante más importante.(AU)

Abstract Objective: To determine which changes are seen in serum pH in critical care patients, during their stay in the Intensive Care Unit, stratifying findings according to the main disorder. Design: Quantitative, observational, analytical study of a retrospective cohort. Setting: Polyvalent Intensive Care Unit. Patients, interventions, variables: 753 patients with normal pH after excluding those with insufficient records and history of tubular acidosis. Data was gathered from the clinical database during a 21-month interval. Using a survival analysis, serum pH changes were stratified in their relation to the basic alteration and morbidity. Difference between groups was estimated using the log-rank test. In patients with metabolic acidosis Cox regression was used to search for determining factors. Results: A total of 753 patients were evaluated (median age: 60 years [IQR: 40-71]). The median length of stay was 8 days (IQR: 6-13). pH was abnormal in 42% of the population. Metabolic acidosis was the predominant finding being more frequent in septic patients. The main cause of acidosis seems to be hypoperfusion; outcomes were similar in alkalotic patients. Conclusions: Changes in pH are frequent in patients admitted to intensive care unit, with an equal proportion of acidosis and alkalosis. Mortality was similar in both disorders. pH can be related with a negative outcome in both alkalosis and acidosis. In the latter group hypoperfusion seems to be the major trigger.(AU)

[ECAIS study: inadvertent cardiovascular adverse events in sepsis]. / Estudio ECAIS: eventos cardiovasculares adversos inadvertidos en sepsis.

OBJECTIVE: To describe the incidence of cardiovascular adverse events in patients with sepsis in its various stages. DESIGN: A longitudinal, descriptive, observational study was carried out. SETTING: Intensive care units of two university hospitals in Bogotá (Colombia). PATIENTS: A number of patients consecutively admitted to the adult ICU with a diagnosis of sepsis, and no evidence of previous ischemic myocardial injury. INTERVENTIONS: Forty-eight hours of electrocardiographic record using Holter technology. MAIN VARIABLES: Ischemia, cardiac arrhythmia, heart rate variability. RESULTS: A total of 100 patients were analyzed, 62% being staged as presenting septic shock. Three percent suffered ischemic events detected by Holter and unnoticed through conventional monitoring. Forty-six percent suffered an arrhythmic event detected by Holter, compared with only 6% as detected by conventional monitoring. Mortality was 40%. All patients showed loss of heart rate variability. CONCLUSION: In this study patients with sepsis showed a low incidence of cardiovascular ischemic events. In contrast, arrhythmic events showed a high incidence. Conventional monitoring failed to detect any of the ischemic events and most arrhythmic events. In this study, cardiovascular events generated by adrenergic discharge had no impact upon mortality.