Complicaciones de la reanimación por fluidoterapia agresiva en pacientes con shock hipovolémico en el Hospital de Especialidades Teodoro Maldonado Carbo durante el periodo 2017-2019.

Abstract

Introduction: Hypovolemic shock is one of the most frequent types of shock and one of the main causes of death in surgical patients and trauma patients. Among its main causes is hemorrhage from traumatic injuries where 2,800,000 hospital admissions, 27,600,000 emergencies and 214 deaths from this pathology were detected in the United States in 2015. The goal of aggressive fluid therapy resuscitation is to achieve tissue perfusion and an adequate oxygenation while correcting any coagulopathy. The choice of solution and the amount used for this purpose is controversial, especially regarding the benefits and adverse effects of each type of solution. Our research purpose is to test the most frequent complications of this technique with different fluids. Materials and methods: An observational, retrospective and analytical study was conducted, data was collected through a database with numbers of medical records and diagnoses provided by the "Teodoro Maldonado Carbo" Specialty Hospital during the period from August 2017 to August 2019. Through the numbers of medical records, the system of this health house (AS400) is accessed and the data is collected according to the registered information. The universe consisted of 167 patients diagnosed with hypovolemic shock who met the inclusion criteria. Results: Most of the patients diagnosed with Hypovolemic Shock showed complications at some point during their hospital stay, which corresponded to 73.05% (122 patients). The most frequent complication when Saline Solution 0.9% was administered is Hyperchloremic Metabolic Acidosis with 11.98% followed by coagulopathy 4.1%, while 3.59% was obtained in Acute Renal Failure. In the case of Ringer's Lactate the main complication was Hyperchloremic metabolic acidosis with 4.79% and Lactic Acidosis with 2.9%. When both solutions were used combined the main complication was Hyperchloremic Metabolic Acidosis with 4.79%, being in all cases the most frequent complication the Hyperchloremic Acidosis with 11.98%. Conclusion: The most frequent complication of immediate, mediate and late form was Hyperchloremic metabolic acidosis when it was administered at a rate of 1000 to 3000 cc; while coagulopathy was more frequent when administering more than 4000 cc (P= 0,016). The most effective crystalloid was Ringer's Lactate with a mortality of 7.78%, followed by the combination of ringer's lactate with saline solution 0.9% with a mortality of 8.95; unlike saline solution which proved to be the least effective with a mortality of 31.54% (P= 0,706). The most frequent complication of the 3 crystalloids used was hyperchloremic metabolic acidosis, however, other complications were also found, such as lactic acidosis when using ringer's lactate and coagulopathy plus metabolic disorders when using both crystalloids in combination (P= 0,002).