MONITORIA EN CUIDADO INTENSIVO DEL PACIENTE CON ENFERMEDAD HEPATICA DIEGO FERNANDO BAUTISTA R. INTERNISTA INTENSIVISTA
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1 MONITORIA EN CUIDADO INTENSIVO DEL PACIENTE CON ENFERMEDAD HEPATICA DIEGO FERNANDO BAUTISTA R. INTERNISTA INTENSIVISTA
2 COMO MONITOREAMOS HOY
3 COMO LO HARIAMOS EN EL FUTURO Frederic Michard, Michael R. Pinsky and Jean-Louis Vincent. Intensive Care Med (2017) 43:
4 MIENTRAS TANTO
5 UNA MIRADA A LA PRACTICA EN U.S.A R. Schumann et al. Anesthesia for liver transplantation in United States academic centers: intraoperative practice. Journal of Clinical Anesthesia (2013) 25,
6 R. Schumann et al. Anesthesia for liver transplantation in United States academic centers: intraoperative practice. Journal of Clinical Anesthesia (2013) 25,
7 R. Schumann et al. Anesthesia for liver transplantation in United States academic centers: intraoperative practice. Journal of Clinical Anesthesia (2013) 25,
8 BIANCOFIORE G, DELLA ROCCA G. Minerva Anestesiol 2012;78:668-74
9 ES PELIGROSO? Classification of Surgical Complications A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Annals of Surgery Volume 240, Number 2, August 2004.
10 ES PELIGROSO? Lu SY, Matsusaki T, Abuelkasem E, Sturdevant ML, Humar A, Hilmi IA, Planinsic RM, Sakai T. Complications related to invasive hemodynamic monitors during adult liver Transplantation. Clin Transplant 2013: 27:
11 METODOS DE TERMODILUCION
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16 Kumar Audimoolam Vinod, Predicting Fluid Responsiveness in Acute Liver Failure: A Prospective Study Anesth Analg 2017;124:480 6)
17 Garutti Ignacio et al. Extravascular Lung Water and Pulmonary Vascular Permeability Index Measured at the End of Surgery Are Independent Predictors of Prolonged Mechanical Ventilation in Patients Undergoing Liver Transplantation. Anesth Analg 2015;121:736 45
18 Garutti Ignacio et al. Extravascular Lung Water and Pulmonary Vascular Permeability Index Measured at the End of Surgery Are Independent Predictors of Prolonged Mechanical Ventilation in Patients Undergoing Liver Transplantation. Anesth Analg 2015;121:736 45
19 Garutti Ignacio et al. Extravascular Lung Water and Pulmonary Vascular Permeability Index Measured at the End of Surgery Are Independent Predictors of Prolonged Mechanical Ventilation in Patients Undergoing Liver Transplantation. Anesth Analg 2015;121:736 45
20 Matthieu Biais et al. Cardiac Output Measurement in Patients Undergoing Liver Transplantation: Pulmonary Artery Catheter Versus Uncalibrated Arterial Pressure Waveform Analysis. Anesth Analg 2008;106:1480 6
21 Matthieu Biais et al. Cardiac Output Measurement in Patients Undergoing Liver Transplantation: Pulmonary Artery Catheter Versus Uncalibrated Arterial Pressure Waveform Analysis. Anesth Analg 2008;106:1480 6
22 VILCHEZ MONGE. Cardiac output monitoring with pulmonary versus transpulmonary thermodilution during liver transplantation: interchangeable methods?. Minerva Anestesiol 2014;80: )
23 VILCHEZ MONGE. Cardiac output monitoring with pulmonary versus transpulmonary thermodilution during liver transplantation: interchangeable methods?. Minerva Anestesiol 2014;80: )
24 Conclusion. Continuous pulmonary thermodilution with PAC is not an alternative monitoring method of CO. Transpulmonary thermodilution CO monitoring with PiCCO2 shows too questionable agreement with the clinical gold standard (PACi) being in the limit of acceptance to be considered interchangeable during liver transplantation VILCHEZ MONGE. Cardiac output monitoring with pulmonary versus transpulmonary thermodilution during liver transplantation: interchangeable methods?. Minerva Anestesiol 2014;80: )
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27 CONCLUSIONS: Our results suggest that Vigileo/FloTrac CO monitoring data do not agree well with those of automatic thermodilution in patients undergoing liver transplantation, especially in Child-Pugh grade B and C patients with low systemic vascular resistance. Biais Matthieu et al. Anesth Analg 2008;106:1480 6
28 DISPOSITIVOS DE ULTIMA GENERACION
29 Biais Matthieu et al, Impact of Systemic Vascular Resistance on the Accuracy of the Pulsioflex Device. Anesth Analg 2017;124:487 93
30 CONCLUSIONS: In patients undergoing liver transplantation, Pulsioflex does not accurately estimate CI. Its accuracy is highly impacted by SVR, and it is not able to track changes in CI when large variations in SVR occur. Biais Matthieu et al, Impact of Systemic Vascular Resistance on the Accuracy of the Pulsioflex Device. Anesth Analg 2017;124:487 93
31 So we use less pulmonary artery catheters But why?* Vincent Jean-Louis, MD, PhD,Crit Care Med 2011 Vol. 39, No. 7
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34 G R A C I A S
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