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Cambios en la microcirculación asociados al uso de infusiones de Milrinona en niños con choque séptico

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dc.contributorNieto, Andrés
dc.contributorLucena, Natalia
dc.contributor.advisorFernandez-Sarmiento, Jaime
dc.creatorSarta Mantilla, Carlos Mauricio
dc.creatorFernández-Sarmiento, Jaime
dc.creatorAcevedo Sedano, Lorena
dc.creatorMulett Hoyos, Hernando
dc.creator.degreeEspecialista en Cuidado Intensivo Pediátrico
dc.creator.degreeLevelMaestría
dc.creator.degreetypeFull time
dc.date.accessioned2023-08-25T12:29:10Z
dc.date.available2023-08-25T12:29:10Z
dc.date.created2023-08-22
dc.date.embargoEndinfo:eu-repo/date/embargoEnd/2024-08-26
dc.descriptionObjetivos: Evaluar los cambios en la microcirculación asociados al uso del milrinona en niños con sepsis. Se utilizó videomicroscopía sublingual para medir flujo y densidad capilar (DC) y región limite perfundida (PBR, parámetro inverso del grosor del glicocálix). El desenlace primario fue los cambios en la microcirculación asociados al uso de milrinona al ingreso y a las 24 horas. Diseño: Cohorte prospectiva realizado de Febrero 2021 – Enero 2022 Lugar: Unidad de cuidados intensivos pediátricos (UCIP) en hospital universitario. Pacientes: Niños con sepsis/choque séptico con y sin infusión de milrinona. Intervención: Ninguna Métodos y resultados principales: Se incluyeron 140 niños (mediana edad 2 años RIQ 0.58-12.1). El 58% de los pacientes recibieron infusión de milrinona. La DC se mantuvo en el grupo que recibió milrinona comparado con el grupo que no recibió (p<0.01). Los menores de dos años con milrinona, tenían mejor DC comparado con los niños mayores (50% vs 25%; OR 0.33; CI 95% 0.12-0.89;p=0.02). En el análisis multivariado controlando variables confusoras los niños que recibieron milrinona tenían menos degradación del glicocálix endotelial comparado con los que no lo recibieron ( aOR 0.34 CI 95% 0.11-0.99; p=0.04). Estos cambios se mantenían a pesar de ferritina y proteína C reactiva elevadas (aOR 0.41; CI 95% 0.18-0.93;p=0.03). Conclusiones: En niños con sepsis, el uso de milrinona se asoció a cambios en la microcirculación. Se encontró persistencia de reclutamiento de capilares luego de 24 horas de su administración, menos heterogeneidad del flujo sanguíneo capilar y menos degradación del glicocálix.
dc.description.abstractObjectives: To evaluate changes in microcirculation (capillary density - blood flow) and the endothelial glycocalyx associated with using milrinone in children with sepsis. Sublingual videomicroscopy was used to assess capillary density (DC4-6 microns and DC7-25 microns), microvascular flow index, and perfused blood region (perfusion boundary region (PBR), inverse parameter of glycocalyx thickness - abnormal > 2.0 microns). The primary outcome was the association between changes in microcirculation and the endothelial glycocalyx related to milrinone use. Design: Prospective cohort study from February 2021 - January 2022. Place: 12-bed pediatric intensive care unit (PICU) in a university hospital. Patients: Children with sepsis/septic shock with and without milrinone infusion. Intervention: None Methods and Main Results: 140 children with a mean age of 2 years (IQR 0.58-12.1) were included. Fifty-eight percent (81/140) of patients received milrinone infusion. The main focus of infection was respiratory (43/140;30.7%). After 24 hours of administering milrinone, it was observed that capillary density (4-6 microns) was maintained only in this group (p<0.01). Children younger than two years who received milrinone had better DC4-6 than older ones (OR 0.33; CI 95% 0.12-0.89;p=0.02). In milrinone patients, capillary blood flow was more homogeneous and capillary recruitment capacity was maintained (p<0.05). Additionally, these children had less endothelial glycocalyx degradation (aOR 0.34 CI 95% 0.11-0.99; p=0.04), which was maintained despite elevated ferritin and C-reactive protein (aOR 0.41; CI 95% 0.18-0.93;p=0.03). The group without milrinone had more organ failure associated with microcirculation dysfunction, glycocalyx degradation (p<0.01) and a lower number of functional recruited capillaries (p<0.01). Elevated PBR was associated with mortality in both groups (p=0.04). Conclusions: in this investigation of children with sepsis, we found that milrinone was associated with changes in microcirculation. We found persistence of capillary recruitment of 4-6 microns after 24 hours of its administration, and maintenance and less heterogeneity of capillary blood flow as well as less degradation of the glycocalyx, particularly in children under two years of age.
dc.format.extent75 pp
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.48713/10336_40754
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/40754
dc.language.isospa
dc.publisherUniversidad del Rosario
dc.publisher.departmentEscuela de Medicina y Ciencias de la Salud
dc.publisher.programEspecialización en Cuidado Intensivo Pediátrico
dc.rightsAttribution-NonCommercial-ShareAlike 4.0 International*
dc.rights.accesRightsinfo:eu-repo/semantics/embargoedAccess
dc.rights.accesoRestringido (Temporalmente bloqueado)
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dc.source.instnameinstname:Universidad del Rosario
dc.source.reponamereponame:Repositorio Institucional EdocUR
dc.subjectChoque séptico
dc.subjectSepsis
dc.subjectMicrocirculacion
dc.subjectMilrinone
dc.subjectEndotelio
dc.subject.keywordShock
dc.subject.keywordSepsis
dc.subject.keywordMicrocirculation
dc.subject.keywordEndothelium
dc.subject.keywordMilrinone
dc.titleCambios en la microcirculación asociados al uso de infusiones de Milrinona en niños con choque séptico
dc.title.TranslatedTitleChanges in microcirculation associated with using milrinone in children with sepsis shock
dc.typebachelorThesis
dc.type.documentTrabajo de grado
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTrabajo de grado
local.department.reportEscuela de Medicina y Ciencias de la Salud
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Correo recibido 24ago2023: Mi nombre es Carlos Mauricio Sarta Mantilla. Soy residente de cuidado intensivo pediátrico. Mi trabajo de grado (" Cambios en la microcirculación asociados al uso de infusiones de Milrinona en niños con choque séptico") en este momento, lo sometí a la Revista Pediatric Critical Care. Es una revista Q1 con un alto nivel de impacto y esta en sometimiento. Mi intensión es publicarla por eso solicito se bloquee por un periodo de un año mientras es sometido y corregido para publicación. Agradezco su colaboracion Atentamente: Carlos Mauricio Sarta Mantilla
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Especialización en Medicina Crítica y Cuidado Intensivo Pediátrico