Monitorización hemodinámica: sistema PiCCO®

Vivas, Andrés; Sánchez, Salvador; Rodriguez, Mario; Silva-Obregón, J. Alberto; Rosado, Santiago; García, Jimena Laiseca

doi:10.1016/s1130-2399(08)72755-x

Cited by 10 publications

(5 citation statements)

References 18 publications

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“…Heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), central venous pressure (CVP), pulse pressure variation (PPV) and systemic vascular resistance index (SVRI) were recorded using a 5F thermistor-tipped fiber optic catheter (PV2015L20N; PULSION Medical System®, Munich, Germany) for thermal dye dilution measurement, placed in the descending aorta via the femoral artery [ 26 ]. Additional catheters were placed in the caudal cava vein.…”

Section: Methodsmentioning

confidence: 99%

Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study

et al. 2016

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IntroductionMechanical intestinal obstruction is a disorder associated with intra-abdominal hypertension and abdominal compartment syndrome. As the large intestine intraluminal and intra-abdominal pressures are increased, so the patient’s risk for intestinal ischaemia. Previous studies have focused on hypoperfusion and bacterial translocation without considering the concomitant effect of intra-abdominal hypertension. The objective of this study was to design and evaluate a mechanical intestinal obstruction model in pigs similar to the human pathophysiology.Materials and MethodsFifteen pigs were divided into three groups: a control group (n = 5) and two groups of 5 pigs with intra-abdominal hypertension induced by mechanical intestinal obstruction. The intra-abdominal pressures of 20 mmHg were maintained for 2 and 5 hours respectively. Hemodynamic, respiratory and gastric intramucosal pH values, as well as blood tests were recorded every 30 min.ResultsSignificant differences between the control and mechanical intestinal obstruction groups were noted. The mean arterial pressure, cardiac index, dynamic pulmonary compliance and abdominal perfusion pressure decreased. The systemic vascular resistance index, central venous pressure, pulse pressure variation, airway resistance and lactate increased within 2 hours from starting intra-abdominal hypertension (p<0.05). In addition, we observed increased values for the peak and plateau airway pressures, and low values of gastric intramucosal pH in the mechanical intestinal obstruction groups that were significant after 3 hours.ConclusionThe mechanical intestinal obstruction model appears to adequately simulate the pathophysiology of intestinal obstruction that occurs in humans. Monitoring abdominal perfusion pressure, dynamic pulmonary compliance, gastric intramucosal pH and lactate values may provide insight in predicting the effects on endorgan function in patients with mechanical intestinal obstruction.

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Section: Methodsmentioning

confidence: 99%

Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study

et al. 2016

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“…La monitorización del GC en los pacientes críticos tiene como objetivo, mantener y optimizar la función cardíaca y conservar una adecuada perfusión tisular. Dicha monitorización se ha realizado desde hace años, mediante inserción de cateter de arteria pulmonar, el cual suscita cada vez mayor controversia debido a la tecnología que aporta datos para poder dilucidar qué ocurre, cómo sucede y conocer una posible causa de la descompensación en pacientes críticos como en choque séptico (Martín et al, 2008). La utilización del catéter de arteria pulmonar sirve para identificar la función cardiaca y la perfusión tisular, datos importantes en nuestro estudio de caso, ya que, gracias a esta intervención se identificó la causa de descompensación, que permitió la mejoría oportuna y el pronto egreso.…”

Section: Discussionunclassified

“…De acuerdo al caso clínico, se localiza una bacteriemia a nivel abdominal, en donde se activa el sistema inflamatorio; los macrófagos fagocitan a las bacterias llevando a sepsis, con la evidencia clínica de la activación de leucocitos; El caso clínico es uno de los de mayor interés a nivel profesional debido a que combina una patología común en las unidades de cuidados intensivos (UCI) y la monitorización hemodinámica invasiva, que también es de gran uso, aunque éste, dentro de algunas literaturas es controversial dado que implica la inserción de un catéter venoso central y femoral, por lo cual se invade al paciente con el fin de ser objetivos en el tratamiento y salvar la vida oportuna y eficazmente (Martín, Saboya, Patiño y Silva, 2008).…”

Section: Introductionunclassified

Choque séptico con monitoria invasiva “Picco”

Eugenia Andrade,

Ordoñez Palacios,

Acosta Romo

2019

Excelsium Scientia Rev. Int. Investig.

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La sepsis es una patología con incidencia de la tercera parte de los pacientes que ingresan a una Unidad de cuidado intensivo, con una tasa de mortalidad del 25 %. El sistema Picco se basa en la inyección de un bolo de suero salino por vía central que, tras su análisis, informa los parámetros hemodinámicos. Se realizó un estudio de caso con una paciente de 51 años con apendicitis aguda y peritonitis generalizada, quien evolucionó en encefalopatía con importante trabajo respiratorio, hipotensa, bradicárdica, con derrame pleural bilateral. Se indica intubación orotraqueal; requiere de dosis supra anormales de vasopresores; progresa en bradicardia extrema y ritmo de paro. El objetivo del presente caso de estudio es comprender el papel que cumple la monitorización Picco en casos de choque séptico, las variables que se monitoriza y la manera como los profesionales de enfermería las interpretan, para elaborar un plan de atención de enfermería.

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“…The APP was indirectly calculated from the mean arterial pressure (MAP) and IAP according to the formula: APP = MAP- IAP [ 15 , 31 ]. MAP were recorded using a 5F thermistor-tipped 10 fiber optic catheter (PV2015L20N; PULSION Medical System®, Munich, Germany) placed in the abdominal aorta via the femoral artery.…”

Section: Methodsmentioning

confidence: 99%

Time-course evaluation of intestinal structural disorders in a porcine model of intra-abdominal hypertension by mechanical intestinal obstruction

Párraga‐Ros¹,

Correa-Martín²,

Sánchez‐Margallo³

et al. 2018

PLoS ONE

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BackgroundA mechanical intestinal obstruction (MIO) can generate intraabdominal hypertension (IAH) that is life threatening. The intestines are very sensitive to IAH since the low splanchnic perfusion causes intestinal hypoxia, local acidosis and bacterial translocations. This may lead to acute intestinal distress syndrome (AIDS). The identification of intestinal injuries during IAH and its correlation with clinical parameters as the abdominal perfusion pressure (APP), the gastric intramucosal pH (pHi) and lactic acid (Lc) are still unknown. This study aimed to evaluate the sequence of intestinal histopathological findings in an MIO model and to analyze potential relationships with parameters currently used in clinical practice (APP, pHi and Lc).Material and methodsTwenty pigs were divided into three groups: a control group (n = 5) and two experimental groups with 20 mmHg (G1, n = 10) and 30 mmHg (G2, n = 5) of IAH by MIO. The pressures were maintained for 3 hours, except in 5 animals in G1 where it was maintained for 5 hours. The APP, pHi and LA were recorded and biopsies of the terminal ileum were taken every 30 minutes in all groups. The intestinal damage was graded according to the Park Score.ResultsIntestinal injuries were found in 42.9% of pigs in the experimental groups. The lesions were independent of the level and duration of IAH. Although APP and pHi were slightly lower in injured animals (I +) of G1 and G2, there were no significant differences among those uninjured (I-). Lc was significantly increased in all I+ pigs from the onset of IAH.ConclusionThe IAH by MIO causes intestinal lesions from the first 30 minutes with concurrent decreases in APP and pHi and increases in Lc. Lc could be the best clinical parameter related to intestinal damages with a clear difference between I + and I- animals.

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Monitorización hemodinámica: sistema PiCCO®

Cited by 10 publications

References 18 publications

Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study

Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study

Choque séptico con monitoria invasiva “Picco”

Time-course evaluation of intestinal structural disorders in a porcine model of intra-abdominal hypertension by mechanical intestinal obstruction

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