De la macrocirculación hacia la microcirculación en el paciente crítico pediátrico. Una Revisión de la literatura
Resumen
El choque en pacientes pediátricos es una entidad que requiere un reconocimiento temprano y rápido con el objetivo de mejorar resultados; sin embargo, no existe un marcador definitivo y único para su detección, es por ello que los signos clínicos y los parámetros hemodinámicos ayuda a su identificación; el choque se caracteriza por una inadecuada oxigenación celular y disfunción orgánica, lo que motiva que los objetivos de la reanimación estén enfocados en normalizar variables sistémicas de la circulación y la oxigenación tisular. Si bien de forma tradicional se ha centrado la atención en parámetros relacionados con la macrocirculación, actualmente se reconoce que la microcirculación, donde ocurre el intercambio de oxígeno y de nutrientes, representa un rol esencial en la restauración celular. Para abordar esta situación, se han desarrollado herramientas de monitoreo en tiempo continuo con el objetivo de vigilar la perfusión regional y global en la cama del paciente, soportados cada vez más con estudios internacionales; dentro de estos destacan el tiempo de llenado capilar, el índice de moteado, el gradiente térmico y los niveles de lactato que ofrecen información sobre el estado de perfusión y permiten guiar la reanimación. En conclusión, integrar la evaluación de la microcirculación en el abordaje del paciente crítico pediátrico ofrece una visión más completa del estado hemodinámico, facilitando intervenciones más eficaces para mejorar la perfusión y reducir la mortalidad.
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