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Vol. 52. Núm. 4.
Páginas 339-345 (abril 2000)
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Vol. 52. Núm. 4.
Páginas 339-345 (abril 2000)
Acceso a texto completo
Eficacia del tratamiento hemodinámico guiado por el pH intramucoso gástrico en niños críticamente enfermos
Effectiveness of hemodynamic treatment guided by gastric intramucosalph monitoring
Visitas
5982
C. Calvo Reya,*, F. Ruza Tarríoa, M.A. Delgado Domíngueza, J. López-Herce Cidb, P. Dorao Martínez-Romilloa
a Unidad de Cuidados Intensivos. Hospital Infantil La Paz. Madrid.
b Unidad de Cuidados Intensivos Pediátricos. Hospital General Gregorio Marañón. Madrid.
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Información del artículo
Objetivo

Valorar la eficacia del pH intramucoso gástrico como guía terapéutica en niños críticamente enfermos.

Métodos

Se ensaya un protocolo de tratamiento hemodinámico en 34 niños críticamente enfermos (médicos y quirúrgicos), con el objetivo final de conseguir la normalización del pH intramucoso gástrico. Se comparan las complicaciones hemodinámicas con otro grupo de pacientes críticos tratados de forma convencional.

Resultados

El tratamiento administrado para mejorar la oxigenación hística (estabilización hemodinámica, expansión de volumen y perfusión de dobutamina) logró elevar los valores del pH intramucoso gástrico desde 7,25 ± 0,04 hasta 7,32 ± 0,13 de media (p = 0,014). Presentaron complicaciones hemodinámicas el 73% de los niños con valores de pH intramucoso gástrico menor de 7,30. Comparamos estos datos con los de un grupo control de 30 niños críticamente enfermos que fueron tratados según las pautas habituales de la unidad de cuidados intensivos pediátricos. En este grupo, desarrollaron complicaciones hemodinámicas el 93,8% de los niños con valores de pH intramucoso gástrico inferior a 7,30 (p = 0,048).

Conclusiones

El pH intramucoso gástrico puede ser útil como guía para el tratamiento hemodinámico de niños críticamente enfermos.

Palabras clave:
pH intramucoso
Tonometría gástrica
Niños
Pacientes
Tratamiento hemodinámico
Objective

To determine whether gastric intramucosal pH can be used as an indicator for the treatment of critically ill children.

Methods

A protocol for hemodynamic treatment was tested in 34 critically ill children (medical and surgical patients). Endpoint was considered as normalization of gastric intramucosal pH. Hemodynamic complications were compared with another group of criticially ill patients who received conventional treatment.

Results

Treatment designed to improve tissue oxygenation (hemodynamic stabilization, volume expansion, and dobutamine perfusion) raised pHi values from 7.25 ± 0.04 to 7.32 ± 0.13 (p = 0.014). Seventy-three percent of the children with pHi < 7.30 presented hemodynamic complications. These findings were compared with the results obtained in a control group of 30 critically-ill children given conventional treatment in the pediatric intensive care unit. In this group, 93.8% of the children with a pHi < 7.30 developed hemodynamic complications.

Conclusions

We conclude that gastric intramucosal pHi can be useful as an indicator for the hemodynamic treatment of critically ill children.

Key words:
Intramucosal pH
Gastric tonometry
Children
Critically ill patients
Hemodynamic therapy
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Este trabajo ha sido parcialmente financiado por el Fondo de Investigaciones Sanitarias. FIS. Beca: 94/0171.

Copyright © 2000. Asociación Española de Pediatría
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