Puesta al día en Medicina Intensiva: Monitorización hemodinámina en el paciente críticoObjetivos de la reanimación hemodinámicaObjectives of hemodynamic resuscitation
Section snippets
Introducción
En la práctica diaria de la medicina crítica, una de las principales preocupaciones del clínico es asegurar el bienestar del tejido mientras se trata de forma específica la enfermedad causante del insulto primario. Cuando nos referimos a bienestar del tejido, nos referimos concretamente a asegurar el aporte de oxígeno y nutrientes a la célula para que esta pueda seguir desarrollando sus funciones básicas, tanto en cuanto al funcionalismo celular intrínseco como la organización del
Presión arterial
Como ya hemos apuntado, la idoneidad de la llegada de oxígeno a los tejidos no sólo depende del flujo sanguíneo, sino que requiere una presión de perfusión del tejido correcta. A valores de presión arterial media por debajo de 60-65 mmHg, la vasculatura de la mayoría de los lechos tisulares pierde su capacidad de autorregulación, derivando en una caída en la presión intravascular con ineficacia para mantener el flujo sanguíneo capilar. En el campo fisiológico, para que se dé un flujo efectivo
Conclusiones
La reanimación hemodinámica debería pasar por la consecución rápida de valores de presión de perfusión del tejido adecuados (PAM), y seguir el proceso de reanimación según variables fisiológicas y metabólicas útiles en la detección de disoxia tisular global. En el momento actual, las variables más valiosas en cuanto a detección de hipoxia tisular son el lactato en sangre y las saturaciones venosas de oxígeno (SvO2 y SvcO2). Así pues, la reanimación hemodinámica deberá estar dirigida a la
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