Evolución de la fuerza muscular en paciente críticos con ventilación mecánica invasiva

• Autores: G. Via Clavero, Marta Sanjuán Navais, M. Menéndez Albuixech, L. Corral Ansa, Gemma Martínez Estalella, A. Díaz-Prieto Huidobro
• Localización: Enfermería intensiva, ISSN 1130-2399, Vol. 24, Nº. 4, 2013, págs. 155-166
• Idioma: español
• DOI: 10.1016/j.enfi.2013.09.001
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• Dialnet Métricas: 1 Cita
• Resumen

  • Objetivo Evaluar la evolución de la fuerza muscular en pacientes críticos con ventilación mecánica (VM) tras la retirada de la sedación y hasta el alta hospitalaria.

    Material y método Estudio de cohortes desarrollado en 2 unidades de cuidados intensivos (UCI) del Hospital Universitari de Bellvitge, de noviembre del 2011 a marzo del 2012. Se incluyó a pacientes consecutivos con VM > 72 h. Variable dependiente: fuerza muscular mediante la escala Medical Research Council (MRC), el primer día que el paciente fue capaz de responder a 3 de 5 órdenes (día 1), cada semana, al alta de la UCI y al alta hospitalaria o 60 días. Variables independientes: factores asociados a la pérdida de fuerza, días libres de VM, días de estancia en la UCI y estancia hospitalaria. Los pacientes se distribuyeron en 2 grupos (MRC < 48, MRC = 48) tras la primera medición.

    Resultados Se evaluó a 34 pacientes. Variables independientes asociadas a pérdida de fuerza: días con SOFA cardiovascular > 2 (p < 0,001) y días con corticoides (p < 0,001). MRC inicial para el grupo MRC < 48: 38 (27-43) y 52 (50-54) para el grupo MRC = 48. La mayor ganancia de fuerza se obtuvo la primera semana (31% versus 52%). Un MRC < 48 se asoció a más días de VM (p < 0,007) y mayor estancia en la UCI (p < 0,003).

    Conclusiones La mayor ganancia de fuerza tras retirar la sedación se consigue la primera semana. La pérdida de fuerza se asocia a un valor de SOFA cardiovascular > 2 y al uso de corticoides. Los pacientes con MRC < 48 presentan mayor duración de la VM y mayor estancia en UCI

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