Impact of managed care model on the access to health services in Colombia

Revista de la Universidad Industrial de Santander. Salud

Cárdenas Angelone, María Eugenia¹  Torres Dueñas, Diego¹  Trujillo, Ana María²  Niño Mantilla, Maria Eugenia¹  Márquez, Ana María² 

[1] Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia;Universidad Industrial de Santander, Bucaramanga, Colombia

关键词: Sepsis;    septic shock;    severe sepsis;    vasopressors;    hypotension;   

DOI  :  

学科分类：医学（综合）

来源: Universidad Industrial de Santander

【 摘 要 】

Introduction:Sepsis is the leading cause of death in intensive care units (ICU) (30 - 50%). Mean arterial pressure (MAP) is the main determinant of tissue perfusion in this patient group. When the PAM-valued is lower than 60 - 65 mmHg, self-regulation of vascular beds is lost and perfusion becomes directly proportional to arterial pressure, and in this moment is required vasopressor therapy to maintain a minimal perfusion pressure and adequate blood flow. Objective: The aim of this study was to establish the association between the use of vasopressors and mortality in patients with severe sepsis or septic shock admitted to the ICU. Methods: We included 132 patients admitted to FOSCAL's (Clínica Carlos Ardila- Lulle) ICU, Clínica Bucaramanga, Hospital Universitario de Santander and Clinica Chicamocha, with diagnosis of sepsis according to the criteria given by the American College of Chest Physicians / Society of Critical Care Medicine (ACCP / SCCM). The analysis described the frequency of use of vasopressors; the site of infection and the association with mortality. Results: The most affected patients were between 71-80 years of age (26.2%) without gender predominance (female: 45.5% - Male: 54.5%). The most common infectious disease was pneumonia (56.1%). On admission to ICU 29.55% of patients had MAP <65 mm Hg. Mortality was 76.3%, which was associated with age and the presence of pneumonia (OR: 8.55, 95% :2,16-33 ,87-P: 0.002). Mortality was higher in patients in which norepinephrine was used, however, when we made the adjusted analysis it lost significance (OR: 2.36, 95% :0,87-6 ,41-p = 0.091). Conclusion: The site of infection is the most important indicator of mortality even with appropriate use of vasopressors and antibiotics. Salud UIS 2011; 43(1): 84-85.

【 授权许可】

Unknown