Sobrecarga Hídrica en Postoperatorio de Cirugía Cardiaca Pediátrica

Ortiz Córdoba, Angélica Lucero

Publicación:
Sobrecarga Hídrica en Postoperatorio de Cirugía Cardiaca Pediátrica

dc.contributor.advisor	Rodríguez Orozco, Diana-Carolina
dc.contributor.advisor	Martínez Vega, Ruth Aralí
dc.contributor.author	Ortiz Córdoba, Angélica Lucero
dc.date.accessioned	2021-05-27T21:10:47Z
dc.date.available	2021-05-27T21:10:47Z
dc.date.issued	2021-03-04
dc.description	Digital	spa
dc.description.abstract	La 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.	spa
dc.description.abstract	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.	eng
dc.description.degreelevel	Pregrado	spa
dc.description.degreename	Especialista en Cuidado Intensivo Pediátrico	spa
dc.description.edition	1 ed.	spa
dc.description.tableofcontents	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 ............................................................................................ 93	spa
dc.format.extent	117 p	spa
dc.format.mimetype	application/pdf	spa
dc.identifier.local	T 78.21 O784s
dc.identifier.uri	https://repositorio.udes.edu.co/handle/001/5094
dc.language.iso	spa	spa
dc.publisher.faculty	Facultad Ciencias de la Salud	spa
dc.publisher.place	Bucaramanga, Colombia	spa
dc.publisher.program	Especialización en Cuidado Intensivo Pediátrico	spa
dc.rights	Derechos Reservados - Universidad de Santander, 2021	spa
dc.rights.accessrights	info:eu-repo/semantics/openAccess	spa
dc.rights.creativecommons	Atribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0)	spa
dc.rights.uri	https://creativecommons.org/licenses/by-nc-nd/4.0/	spa
dc.subject.proposal	Sobrecarga hídrica	spa
dc.subject.proposal	Unidad de Cuidado Intensivo	spa
dc.subject.proposal	Cardiopatía congénita	spa
dc.subject.proposal	Prevalencia	spa
dc.subject.proposal	Incidencia	spa
dc.subject.proposal	Fluid overload	eng
dc.subject.proposal	Intensive Care Unit	eng
dc.subject.proposal	Congenital heart disease	eng
dc.subject.proposal	Prevalence	eng
dc.subject.proposal	Incidence	eng
dc.title	Sobrecarga Hídrica en Postoperatorio de Cirugía Cardiaca Pediátrica	spa
dc.type	Trabajo de grado - Especialización	spa
dc.type.coar	http://purl.org/coar/resource_type/c_7a1f	spa
dc.type.content	Text	spa
dc.type.driver	info:eu-repo/semantics/bachelorThesis	spa
dc.type.redcol	https://purl.org/redcol/resource_type/TP	spa
dc.type.version	info:eu-repo/semantics/draft	spa
dcterms.audience	Todas las Audiencias	spa
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