Significado de la saturación venosa central en la sepsis experimental

Eliana Cardarello, Marcelo Méndez, Leticia Pérez, Ivanna Pertuso, Valentina Sugo, Juan C Grignola, Francisco Javier Hurtado

Resumen


La saturación venosa mixta es un parámetro clave para evaluar el metabolismo del oxígeno y la perfusión tisular en condiciones patológicas. Dado que su medida puede ser compleja, se ha propuesto
la saturación venosa central, en cava superior como su equivalente. Esta última, usada por más de 10 años en el Protocolo de Resucitación Precoz Guiado por Objetivos, para el manejo del shock séptico, ha sido cuestionada por estudios recientes. El objetivo del trabajo fue evaluar la saturación venosa de diferentes compartimientos vasculares, en un modelo experimental de shock endotóxico. Se realizó un análisis secundario de una base de datos obtenidos del Proyecto: “Sepsis y disfunción multiorgánica.
Resucitación precoz guiada por objetivos y terapias coadyuvantes” del Departamento de Fisiopatología.
Existió una correlación significativa entre saturación venosa central y mixta, pero ambas medidas no pueden ser consideradas equivalentes. El valor promedio de la diferencia entre ambas fue de -0.22 % y los límites de concordancia obtenidos fueron muy extensos. La contribución de los distintos compartimientos vasculares al valor de la saturación venosa mixta, varía con el patrón hemodinámico generado por el tratamiento de resucitación. Descensos y aumentos de la saturación mixta se acompañaron de incrementos significativos del Lactato plasmático. Así, valores altos de la misma no descartan disoxia
tisular. La medida simultánea de saturación mixta y de lactato plasmático puede ayudar a identificar alteraciones de la oxigenación tisular durante el shock endotóxico.


Palabras clave


sepsis; shock endotóxico; saturación venosa mixta; saturación venosa central

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Referencias


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