Revisão sistemática dos marcadores de otiminização da perfusão tecidual em ensaios clínicos aleatórios de cirurgias de alto risco
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Data
2010-02-18
Autores
Gurgel, Sanderland José Tavares [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Pacientes cirúrgicos com reserva orgânica limitada são considerados de alto risco e possuem uma taxa de mortalidade maior do que a esperada, necessitando, portanto, de um protocolo de controle hemodinâmico peroperatório mais rigoroso, no sentido de impedir situações de hipoperfusão tissular. O objetivo desta dissertação é rever de maneira sistemática, os estudos clínicos aleatórios controlados que utilizaram algum tipo de protocolo de otimização hemodinâmica da perfusão tissular em pacientes cirúrgicos com alto risco para complicações no pós-operatório. Foi realizada uma busca computadorizada nas bases de dados da MEDLINE, EMBASE, LILACS, COCHRANE, utilizando o cruzamento de termos médicos, e recuperado estudos clínicos aleatórios controlados, de pacientes cirúrgicos submetidos de maneira controlada, a algum tipo de protocolo de otimização hemodinâmica peroperatória com objetivo de reduzir taxa de mortalidade, número de disfunções orgânicas e dias de internação hospitalar, sendo realizada uma metanálise dos resultados obtidos. Foram recuperados 31 estudos clínico, cuja metanálise global demonstrou uma redução estatisticamente significativa no odds ratio para taxa de mortalidade (odds ratio de 0,71 com 95% de intervalo de confiança entre 0,58-0,87), no número de pacientes com disfunções orgânicas no pósoperatório (odds ratio de 0,64 com 95% de intervalo de confiança entre 0,57- 0,73) e no tempo de internação hospitalar (diferença de médias de -1,06 com 95% de intervalo de confiança entre -1,19/-0,93). Ficando mais evidente nos estudos com taxa de mortalidade maior que 20%. Houve um benefício estatisticamente significativo na redução da taxa de mortalidade com a utilização do cateter da artéria pulmonar para aferição do débito cardíaco (odds ratio de 0,71 com 95% de intervalo de confiança entre 0,57-0,89) e utilização das...
Surgical patient with limited organic reserve are considered of high risk and possess a rate of larger mortality than the expected, needing, therefore, of a protocol of control hemodynamic more rigorous , in the sense of impeding situations of hypoperfusion tissue in the peroperative period. The objective of this dissertation is to review in a systematic way, the random clinical studies controlled that used some type of protocol of hemodynamic optimization of the perfusion tissue in patient surgical with high risk for complications in the postoperative one. A computerized search was accomplished in the bases of data of MEDLINE, BASE, LILACS, COCHRANE, using the crossing of medical terms, and recovered random clinical studies controlled of patient surgical submitted in the some type of protocol of hemodynamic optimization in the preoperative period with objective of reducing mortality rate, number of organic dysfunctions and length of hospital stay, being accomplished a meta-analysis of the obtained results. 31 clinical studies were recovered, whose global meta-analyses demonstrated a reduction significant in the odds ratio for mortality rate (odds ratio of 0,71 with 95% of confidence interval among 0,58-087), in the number of patients with organic dysfunctions in the postoperative (odds ratio of 0,64 with 95% of confidence interval among 0,57-073) and in the length of hospital stay (it differentiates of averages of -1,06 with 95% of confidence interval among - 1,19 /-093), being more evident in the studies with rate of larger mortality than 20%. There was a benefit significant in the reduction of the mortality rate with the use of the catheter of the lung artery for gauging of the heart debit (odds ratio of 0,71 with 95% of trust interval among 0,57-089) and use of the derived variables of the transport and consumption of oxygen (odds ratio of 0,75 with 95% oconfidencef interval among - ... (Complete abstrct click electronic access below)
Surgical patient with limited organic reserve are considered of high risk and possess a rate of larger mortality than the expected, needing, therefore, of a protocol of control hemodynamic more rigorous , in the sense of impeding situations of hypoperfusion tissue in the peroperative period. The objective of this dissertation is to review in a systematic way, the random clinical studies controlled that used some type of protocol of hemodynamic optimization of the perfusion tissue in patient surgical with high risk for complications in the postoperative one. A computerized search was accomplished in the bases of data of MEDLINE, BASE, LILACS, COCHRANE, using the crossing of medical terms, and recovered random clinical studies controlled of patient surgical submitted in the some type of protocol of hemodynamic optimization in the preoperative period with objective of reducing mortality rate, number of organic dysfunctions and length of hospital stay, being accomplished a meta-analysis of the obtained results. 31 clinical studies were recovered, whose global meta-analyses demonstrated a reduction significant in the odds ratio for mortality rate (odds ratio of 0,71 with 95% of confidence interval among 0,58-087), in the number of patients with organic dysfunctions in the postoperative (odds ratio of 0,64 with 95% of confidence interval among 0,57-073) and in the length of hospital stay (it differentiates of averages of -1,06 with 95% of confidence interval among - 1,19 /-093), being more evident in the studies with rate of larger mortality than 20%. There was a benefit significant in the reduction of the mortality rate with the use of the catheter of the lung artery for gauging of the heart debit (odds ratio of 0,71 with 95% of trust interval among 0,57-089) and use of the derived variables of the transport and consumption of oxygen (odds ratio of 0,75 with 95% oconfidencef interval among - ... (Complete abstrct click electronic access below)
Descrição
Palavras-chave
Anestesiologia, Cirurgia, Hemodynamic optimization, Fluid therapy
Como citar
GURGEL, Sanderland José Tavares. Revisão sistemática dos marcadores de otiminização da perfusão tecidual em ensaios clínicos aleatórios de cirurgias de alto risco. 2010. 156 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2010.