Escalas de severidad en cuidados intensivos

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Aldemar Yanett Granados
Guillermo Trout Guardiola
Marlon Martínez
Dinora Sánchez
Ediltrudis Ramos De la Cruz
Ángela Romero Cárdenas

Resumen

ResumenLas escalas de severidad aplicadas en unidades de cuidados intensivos son herramientas de gran utilidad para determinar la magnitud de una condición clínica y de esta manera establecer el pronóstico del paciente. Sin embargo, no deben ser utilizadas para determinar criterios de admisión a estas unidades y, mucho menos, para de acuerdo al puntaje obtenido, tomar conductas diagnósticas y terapéuticas sin base en estudios clínicos. A través del tiempo, los cambios de las características de los pacientes ingresados en las unidades de cuidados intensivos junto con las nuevas tendencias diagnósticas y terapéuticas han hecho que las escalas mas utilizadas sobreestimen la probabilidad de muerte de los pacientes admitidos. Es por ello, que a medida que esto ocurra las escalas deben ser sometidas a intervenciones con el fin de actualizarlas sin que pierdan validez y eficacia. El objetivo de este artículo es brindarle el conocimiento básico y actualizado para la implementación de las escalas mas aplicadas en la mayoría de las unidades de cuidados intensivos. (Duazary 2009 I; 71-75)AbstractScales of severity applied in intensive care units are tools very useful to determine magnitude of a clinical condition and to establish prognosis of the patient. Nevertheless they don´t have to be used to determine criteria of admission to these units, much less according to the obtained score, to take diagnostic and therapeutic conducts without base to clinical studies. Through time, the changes of the characteristics of patients entered the intensive care units along with the new diagnostic and therapeutic tendencies have done that the more used scales overestimate probability of death of the admitted patients. For this reason, in proportion to this happens the scales must be put under interventions to update them without they lose validity and effectiveness.The objective of this article is to offer you the basic and updated knowledge for the implementation of the more applied scales in the majority of the intensive care units.Key words: Prognosis; severity; scale; variable; calibration; discrimination; MPM; APACHE.

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Granados, A. Y., Trout Guardiola, G., Martínez, M., Sánchez, D., Ramos De la Cruz, E., & Romero Cárdenas, Ángela. (2009). Escalas de severidad en cuidados intensivos. Duazary, 6(1), 71–75. https://doi.org/10.21676/2389783X.696
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Moreno R, Apolone G. The impact of different customization strategies in the performance of a general severity score. Crit Care Med 1997; 25:2001–2008.

Cook SF, Visscher WA, Hobbs CL, et al: Project IMPACT Clinical Implementation Committee. Project IMPACT: Results from a pilot validity study of a new observational database. Crit Care Med 2002; 30:2765–2770.

Harrison DA, Brady AR, Parry GJ, et al. Recalibration of risk prediction models in a large multicenter cohort of admissions to adult, general critical care units in the United Kingdom. Crit Care Med 2006; 34:1378–1388.

Moreno R, Matos R. The ‘new’ scores: what problems have been fixed, and what remain. Curr Opin Crit Care 2000; 6:158–165.

Sinuff T, Adhikari NKJ, Cook DJ, et al. Mortality predictions in the intensive care unit: Comparing physicians with scoring systems. Crit Care Med 2006; 34:878–885.

Rowan KM, Kerr JH, Major E, et al. Intensive Care Society's APACHE II study in Britain and Ireland - II: Outcome comparisons of intensive care units after adjustment for case mix by the American APACHE II method. Br Med J 1993; 307:977–981.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985 Oct; 13(10):818-29.

Polderman KH, Christiaans HM, Wester JP, Spijkstra JJ, Girbes AR. Intra-observer variability in APACHE II scoring. Intensive Care Med 2001 Sep;27(9):1550-2.

Capuzzo M, Valpondi V, Sgarbi A, Bortolazzi S, Pavoni V, Gilli G, Candini G, Gritti G, Alvisi R. Validation of severity scoring systems SAPS II and APACHE II in a single-center population. Intensive Care Med 2000 Dec;26(12):1779-85.

Edwards AT, Ng KJ, Shandall AA, Price-Thomas JM. Experience with the APACHE II severity of disease scoring system in predicting outcome in a surgical intensive therapy unit. J R Coll Surg Edinb 1991 Feb;36(1):37-40.

Knaus WA, Wagner DP. The APACHE III. Prognostic system. CHEST 1991; 100: 1619-1636.

Wagner D, Draper E, Knaus W: Chapter 5. Development of APACHE III. Crit Care Med 1989; 17:S199–S203.

Bernard GR, Vincent JL, Laterre PF, et al. Efficacy and safety recombinant human activated protein C for severe sepsis. NEJM. 2001; 344, 609-709.

Zimmerman JE, Kramer AA, McNair DS. APACHE IV:Hospital mortality assessment for today ¨s critically ill patients. Crit Care Med 2006. vol 34 No 5 1297- 1310.

Lemeshow S, Teres D, Klar J, et al. Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA 1993; 270:2478–2486.

Glance LG, Osler TM, Dick AW: Identifying quality outliers in a large, multiple-database by using customized versions of the Simplified Acute Physiology Score II and the Mortality Probability Model II. Crit Care Med 2002; 30:1995–2002.

Higgins TL, Teres D, Copes WS, et al: Assessing contemporary intensive care unit outcome: An updated Mortality Probability Admission Model (MPM0-III). Crit Care Med 2007; 35:827-835.

Higgins T, Teres D, Copes W, et al. Preliminary update of the Mortality Prediction Model (MPM0) [abstract]. Crit Care 2005; 9:S97.

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