Extracción de oxígeno como predictor de mortalidad en pacientes con ventilación con alta frecuencia

• Autores: J.A. García-Hernández, Antonio Vázquez Florido, Adoración I. Martínez López, JM Praena-Fernández, Aurelio Cayuela Domínguez, J. Cano-Franco, M. Loscertales Abril
• Localización: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría ( AEP ), ISSN-e 1696-4608, ISSN 1695-4033, Vol. 78, Nº. 2, 2013, págs. 94-103
• Idioma: español
• Títulos paralelos:
  • Oxygen extraction as a predictor of mortality in patients on high frequency ventilation
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• Resumen

  • ntroduction: The high frequency oscillatory ventilation (HFOV) may reduce cardiac output.

    The haemodynamics were analysed and predictors of mortality identi?ed.

    Patients and methods: A total of 48 children with respiratory failure undergoingHFOV between January 2003 and December 2010 were included. The study design was prospective, observational, and descriptive. Inclusion criteria were based on the existence of hypoxemia. The variables studied were: arterial and central venous pressure, arterial pH, venous saturation and oxygen extraction ratio, with determinations performed priorto HFOV, during, and before turning to conventional ventilation. Prognostic factors were identi?ed by bivariate analysis and a predictive model of mortality was developed.

    Results: The mean age was 21 [4 to 72] months.On admission, PRISM scales and Murray were 33 and 2.8, PaO2/FiO2 of 61 and oxygenation index of 35. After HFOV an increase in pH (P<.001), mean arterial pressure (P<.001) and venous saturation, and decreased venous pressure and O2 extraction (P<.001), was obtained. The prognostic factors of mortality at 24hours after starting HFOV were: FiO2, PaO2/FiO2, oxygenation index, shunt, pH, central venous pressure and mean arterial pressure, venous saturation, and O2 extraction. The model developed at 12hours, consisting of EtO2 and SvcO2 was able to predict death with a probability of 92.3%.

    Conclusions: HFOV improves haemodynamics. The model at 12hours is the best predictor of death.