ABSTRACT
OBJECTIVES: Although aggressive fluid therapy during the first days of hospitalization is recommended by most guidelines and reviews on acute pancreatitis (AP), this recommendation is not supported by any direct evidence. We aimed to evaluate the association between the amount of fluid administered during the initial 24 h of hospitalization and the incidence of organ failure (OF), local complications, and mortality. METHODS: This was a prospective cohort study. We included consecutive adult patients admitted with AP. Local complications and OF were defined according to the Atlanta Classification. Persistent OF was defined as OF of >48-h duration. Patients were divided into three groups according to the amount of fluid administered during the initial 24 h: group A: <3.1 l (less than the first quartile), group B: 3.1-4.1 l (between the first and third quartiles), and group C: >4.1 l (more than the third quartile). RESULTS: A total of 247 patients were analyzed. Administration of >4.1 l during the initial 24 h was significantly and independently associated with persistent OF, acute collections, respiratory insufficiency, and renal insufficiency. Administration of <3.1 l during the initial 24 h was not associated with OF, local complications, or mortality. Patients who received between 3.1 and 4.1 l during the initial 24 h had an excellent outcome. CONCLUSIONS: In our study, administration of a small amount of fluid during the initial 24 h was not associated with a poor outcome. The need for a great amount of fluid during the initial 24 h was associated with a poor outcome; therefore, this group of patients must be carefully monitored.
Subject(s)
Fluid Therapy , Pancreatitis, Acute Necrotizing/therapy , Adult , Aged , Aged, 80 and over , Cohort Studies , Evidence-Based Medicine , Female , Fluid Therapy/adverse effects , Humans , Male , Middle Aged , Pancreatitis, Acute Necrotizing/etiology , Predictive Value of Tests , Prognosis , Prospective Studies , Severity of Illness Index , Time Factors , Treatment OutcomeABSTRACT
La hemorragia gastrointestinal es una complicación frecuente en enfermedades del aparato digestivo, que requiere un seguimiento a cargo de una unidad de semicríticos, como la Unidad de Sangrantes Digestivos (USD). En el seguimiento de estos pacientes se determina diariamente la hemoglobina, por lo que se necesita un método rápido y fiable. Objetivo:Estudiar la fiabilidad del HemoCue® en pacientes con hemorragia gastrointestinal y determinar si hay diferencias en la medición de hemoglobina entre el HemoCue® y el laboratorio de referencia. Material y métodos:Estudio transversal observacional de muestras emparejadas de 54 pacientes tratados en la USD. La hemoglobina de los pacientes con hemorragia digestiva, tanto en la fase aguda (24h tras el sangrado) como en la fase hemodinámicamente estable, se midió con el HemoCue® (Angelholm, Suiza) y, simultáneamente, con el laboratorio. Los resultados se expresan como medias; para la comparación de medias se utilizaron el test de la t de Student para datos emparejados, el test de la r de Pearson para las correlaciones y el análisis de Bland y Altman para la cuantificación de las diferencias.Resultados: La etiología de la hemorragia en los 54 pacientes (34 varones) fue úlcera gastroduodenal en 26 casos, várices esofágicas en 8 casos, esofagitis en 6 casos, síndrome de Mallory-Weiss en 4 casos, gastropatía de la hipertensión portal en 9 casos y otras causas en un caso.En la fase aguda, la presión arterial media (PAM) fue de 83,8mmHg, la hemoglobina media medida con HemoCue® fue de 8,07g/dl en 0,81min en sangre capilar y la hemoglobina media medida con el laboratorio fue de 8,17g/dl en 44,87min en sangre venosa. El coeficiente de correlación r fue de 0,979. En la fase estable, la PAM fue de 100,7mmHg; la hemoglobina medida con HemoCue® fue de 9,32g/dl en 0,8min, y la medida con el laboratorio fue de 9,4g/dl en 47,83min. El coeficiente de correlación r en la fase estable fue de 0,966 (AU)
Gastrointestinal hemorrhage is a frequent complication in digestive diseases, requiring follow-up by specialized units such as the digestive bleeding unit. Hemoglobin is determined daily in the management of these patients, and consequently a rapid and reliable method for hemoglobin determination is required. Objective:To study the reliability of HemoCue® in patients with gastrointestinal hemorrhage and to determine whether there are any differences in hemoglobin measurement between HemoCue® and the reference laboratory.Materials and methodsWe performed a cross-sectional, observational paired sample study of 54 patients treated in the digestive bleeding unit. Hemoglobin was measured simultaneously by HemoCue® (Angelholm, Switzerland) and by laboratory determination in patients with gastrointestinal bleeding, both in the acute phase (first 24h of bleeding) and in the stable phase. The results are expressed as means. To compare means, Student's t-test was used for paired data, Pearson's r was used for correlations and Bland and Altman analysis was used to quantify differences.Results: Fifty-four patients (34 males) were included. The cause of the hemorrhage was duodenal/gastric ulcer in 26 patients, variceal bleeding in eight, esophagitis in five, Mallory Weiss syndrome in four, portal hypertensive gastropathy in nine and other causes in one. In the acute phase, mean arterial pressure (MAP) was 83.8, mean hemoglobin in capillary blood was 8.07g/dl by HemoCue® in 0.81min, and mean hemoglobin in venous blood was 8.17 by laboratory determination in 44.87min. Pearson's correlation coefficient was 0.979. In the stable phase, MAP was 100.7, and hemoglobin with HemoCue® was 9.32 in 0.8min and 9.4 by laboratory determination in 47.83min. Pearson's correlation coefficient in the stable phase was 0.966 (AU)
Subject(s)
Humans , Hemoglobinometry/instrumentation , Gastrointestinal Hemorrhage/blood , Hemoglobins/analysis , Mallory-Weiss Syndrome/diagnosis , Esophageal and Gastric Varices/diagnosis , Peptic Ulcer/diagnosisABSTRACT
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