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Marcadores pronosticos de mortalidad en el postoperatorio de las cardiopatías congenitas


, : Marcadores pronosticos de mortalidad en el postoperatorio de las cardiopatías congenitas.

Identificar los factores de riesgo de mortalidad postoperatoria para establecer indicaciones de oxigenaci n con membrana extracorp rea en ni os cardi patas. Pacientes y m todos Entre abril del 27 y junio del 29 fueron intervenidos 186 ni os con circulaci n extracorp rea. Se determinaron en sangre arterial y venosa, al ingreso en UCIP y a las 22 horas, el pH, la pCO2, la SatO2 y el exceso base, y el CO2 en aire espirado. El lactato se midi en quir fano, al ingreso en UCIP y durante el postoperatorio, para determinar el tiempo en que se mantuvo elevado, su pico m ximo, y la velocidad de variaci n. Se calcul adem s, la diferencia arteriovenosa de la saturaci n de ox geno, su extracci n tisular, la fracci n de espacio muerto y el shunt intrapulmonar. La mortalidad hospitalaria fue del 13,4%. Se identificaron como factores de riesgo de mortalidad, la edad, el tiempo de extracorp rea, el score inotr pico; el lactato al ingreso, su pico m ximo, la velocidad de variaci n y el tiempo en que estuvo elevado; la saturaci n venosa, el exceso de base, el espacio muerto, la extracci n de ox geno, y el shunt intrapulmonar. Las variables que mostraron mayor valor predictivo de mortalidad fueron el tiempo de extracorp rea, el lactato al ingreso y su pico m ximo. En el an lisis multivariante se detectaron como variables independientes de mortalidad, un pico de lactato de 6,3mmol/l y un tiempo hiperlactacidemia de 24 h. La elevaci n m xima del lactato posee una alta capacidad predictiva de mortalidad y nos permitir iniciar precozmente la oxigenaci n con membrana extracorp rea. Our aim is to identify risk factors for mortality after surgery for congenital heart disease in children, in order to establish indications for extracorporeal membrane oxygenation (ECMO). One hundred and eighty six children underwent cardiac surgery with extracorporeal circulation from April 27 to June 29. The following parameters were measured serially during their stay in Paediatric Intensive Care (PICU): Arterial and venous blood pH, pCO2, base excess, oxygen saturation, arterio-venous oxygen saturation difference, oxygen extraction ratio, ventilatory dead space and intrapulmonary shunting. Hospital mortality was 13,4%. The following risk factors for mortality were identified: age, bypass time, inotropic score, lactate level upon arrival in PICU including its peak value and its rate of variation, mixed venous saturation, base excess, ventilatory dead space, oxygen extraction ratio, and intrapulmonary shunting. However, the strongest predictors of mortality were bypass time, lactate levels upon admission on PICU, and the peak lactate level. Multivariate analysis showed a lactate level of 6.3mmol/l and a high blood lactate for 24hours to be independent predictors of mortality. The peak lactate level is a strong predictor of mortality. As such, it would be a useful indicator of the need for ECMO support.

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