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Relación entre la presión arterial parcial de oxígeno después de la reanimación por paro cardíaco y la mortalidad en

Lee P Ferguson¹, Andrew Durward, Shane M Tibby

¹Pediatric Intensive Care Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom. lee.ferguson7@nuth.nhs.uk

|June 23, 2012

Resumen

Tanto los niveles bajos como altos de oxígeno arterial aumentan el riesgo de muerte en niños después de un paro cardíaco. Las directrices actuales sugieren evitar la hiperoxia, pero este estudio muestra que ambos extremos son peligrosos para la supervivencia de la unidad de cuidados intensivos pediátricos (UCIP).

Área de la Ciencia:

Medicina de cuidados intensivos pediátricos para niños.
Resultados de la reanimación cardiopulmonar.
Unidad de cuidados intensivos pediátricos (UIPP) de investigación.

Sus antecedentes:

Los estudios en adultos relacionan la hiperoxia después del paro cardíaco con peores resultados.
Las directrices pediátricas actualmente aconsejan contra la hiperoxia, basada en datos de adultos.
El impacto de los niveles de oxígeno arterial en la supervivencia del paro cardíaco pediátrico no está bien establecido.

Objetivo del estudio:

Investigar la relación entre la presión parcial arterial de oxígeno (PaO2) y la supervivencia en pacientes pediátricos después de un paro cardíaco.
Determinar la asociación entre el estado de oxigenación y la mortalidad en la unidad de cuidados intensivos pediátricos (UCIP).

Principales métodos:

Estudio de cohorte retrospectivo utilizando la base de datos de la Red de Auditoría de Cuidados Intensivos Pediátricos (PICANet) (2003-2010).
Se incluyeron pacientes menores de 16 años con paro cardíaco antes de la admisión a la PICU y análisis de gases en la sangre arterial dentro de 1 hora.
La regresión logística y los polinomios fraccionarios multivariables modelaron la relación entre la mortalidad por PaO2 y PICU, ajustando las covariables.

Principales resultados:

Se encontró una relación no lineal significativa entre la mortalidad por PaO2 y la mortalidad por PICU.
La hipoxia (PaO2 <60 mm Hg) se asoció fuertemente con un aumento de la mortalidad (OR 1.92).
La hiperoxia (PaO2 ≥300 mm Hg) también se asoció con un aumento de la mortalidad, aunque de manera menos dramática (OR 1.25).

Conclusiones:

Tanto la hipoxia severa como la hiperoxia están vinculadas a un mayor riesgo de muerte en niños después de un paro cardíaco.
Los hallazgos sugieren que el manejo óptimo del oxígeno en la reanimación pediátrica requiere una cuidadosa consideración de ambos extremos.
La edad y la presencia de enfermedad cardíaca congénita modifican aún más el riesgo de mortalidad en estos pacientes.

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