Parámetros de atrofia muscular como predictores de desenlaces clínicos en pacientes de Unidad de Cuidados Intensivos

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dc.contributor.advisorHernández-Álvarez, Edgar Debray
dc.contributor.authorGuzmán-David, Cristian Arvey
dc.contributor.cvlac0001535680spa
dc.contributor.orcid0000-0001-6259-8210spa
dc.contributor.researchgroupProfundización en Kinesioterapiaspa
dc.date.accessioned2023-07-05T14:51:26Z
dc.date.available2023-07-05T14:51:26Z
dc.date.issued2023-07-04
dc.descriptionilustraciones, fotografíasspa
dc.description.abstractLa atrofia muscular implica alteraciones de tipo estructural y funcional relacionadas con la producción de fuerza muscular y movimiento. Esta condición se ha informado como la principal razón de la presencia de debilidad muscular generalizada; refleja la gravedad de la enfermedad y puede tener un impacto profundo en los resultados clínicos a corto y largo plazo, tales como: prolongación del tiempo con soporte ventilatorio, aumento de la estancia en Unidad de Cuidados Intensivos (UCI), disminución del estado funcional, extensión en las cifras de mortalidad, entre otras. Objetivo: Determinar si los parámetros de atrofia muscular mediante ecografía predicen tempranamente la debilidad muscular, morbilidad (días en Ventilación Mecánica (VM), días libres de VM y días de estancia en UCI), y mortalidad a 28 días en pacientes de la UCI del Hospital Universitario Nacional de Colombia. Tipo de estudio: Estudio observacional analítico tipo cohorte prospectiva. Metodología: Se incluyeron pacientes mayores de 18 años con patologías médicas o quirúrgicas, que requerían ventilación mecánica por más de 24 horas. Se excluyeron sujetos con comorbilidades que impedían la valoración de la fuerza muscular. Se registraron variables demográficas, diagnóstico, y factores de riesgo para debilidad muscular. El factor de exposición fue la atrofia muscular medida por ecografía. Los desenlaces considerados fueron fuerza muscular mediante Medical Research Council (MRC), fuerza muscular respiratoria, dinamometría manual y morbimortalidad. El análisis estadístico fue efectuado con el programa IBM-SPSS-Versión 19. Resultados: Se analizaron los resultados de 31 pacientes, 54.8% fue del sexo masculino, la edad promedio fue de 62.52 ±15,39. Las medidas de Área de Sección Transversal (AST) al inicio para cuádriceps derecho e izquierdo fue de 3,89 ±1,48 y 3,78 ±1,44cm2, mientras que el espesor muscular (EM) fue de 1,08 ±0,37 y 1,06 ±0,32cm respectivamente. A las 72 horas todas estas medidas presentaron disminución que osciló entre 5,39 a 16,96%. La atrofia mayor al 10% se presentó en el 58% del total de la cohorte. Se identificaron Odds Ratios (OR) que sugieren riesgo clínico de desenlaces como Debilidad Muscular Adquirida en la Unidad de Cuidados Intensivos (DAUCI) o morbilidad. Conclusión: Los pacientes analizados presentaron una pérdida consistente de la masa muscular en un periodo relativamente temprano. La ecografía muscular puede ser considerada como herramienta para el seguimiento temprano de la pérdida de masa muscular. La presencia de atrofia muscular confiere un mayor riesgo clínico para el desarrollo de DAUCI de extremidades y prensión manual. (Texto tomado de la fuente)spa
dc.description.abstractMuscle atrophy involves structural and functional alterations related to muscle strength production and movement. This condition has been reported as the main reason for the presence of generalized muscle weakness; it reflects the severity of the disease and can have a profound impact on short- and long-term clinical outcomes, such as: prolongation of time on ventilatory support, increased Intensive Care United (ICU) stay, decreased functional status, increased mortality, among others. Objective: To determine whether muscle atrophy parameters by ultrasound predict early muscle weakness, morbidity (days in Mechanical Ventilation (MV), days free of MV and days of ICU stay), and 28-day mortality in patients in the ICU of the Hospital Universitario Nacional de Colombia. Type of study: Analytical observational prospective cohort study. Methodology: Patients older than 18 years with medical or surgical pathologies that requiring mechanical ventilation for more than 24 hours were included. Subjects with comorbidities that prevented the assessment of muscle strength were excluded. Demographic variables, diagnosis, and risk factors for muscle weakness were recorded. The exposure factor was muscle atrophy measured by ultrasound. The outcomes considered were muscle strength by Medical Research Council (MRC), respiratory muscle strength, manual dynamometry, morbidity and mortality. Statistical analysis was performed with IBM-SPSS-Version 19. Results: The results of 31 patients were analyzed, 54.8% were male, the average age was 62.52 ±15.39. The cross-sectional area (CSA) measurements at baseline for right and left quadriceps were 3.89 ±1.48 and 3.78 ±1.44cm2, while muscle thickness (MT) was 1.08 ±0.37 and 1.06 ±0.32cm respectively. At 72 hours all these measurements showed a decrease ranging from 5.39 to 16.96%. Atrophy greater than 10% was present in 58% of the total cohort. Odds Ratios (OR) were identified suggesting clinical risk of outcomes such as Intensive Care Unit Acquired Muscle Weakness (ICUAW) or morbidity. Conclusion: The patients analyzed presented a consistent loss of muscle mass in a relatively early period. Muscle ultrasound can be considered as a tool for early monitoring of muscle wasting. The presence of muscle atrophy confers an increased clinical risk for the development of limb ICUAW and manual grip.eng
dc.description.degreelevelMaestríaspa
dc.description.degreenameMagíster en Fisiologíaspa
dc.description.researchareaSalud Muscular, Cuidado Crítico y Biomarcadoresspa
dc.format.extent101 páginasspa
dc.format.mimetypeapplication/pdfspa
dc.identifier.instnameUniversidad Nacional de Colombiaspa
dc.identifier.reponameRepositorio Institucional Universidad Nacional de Colombiaspa
dc.identifier.repourlhttps://repositorio.unal.edu.co/spa
dc.identifier.urihttps://repositorio.unal.edu.co/handle/unal/84141
dc.language.isospaspa
dc.publisher.branchUniversidad Nacional de Colombia - Sede Bogotáspa
dc.publisher.facultyFacultad de Medicinaspa
dc.publisher.placeBogotá,Colombiaspa
dc.publisher.programBogotá - Medicina - Maestría en Fisiologíaspa
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dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.licenseAtribución-NoComercial 4.0 Internacionalspa
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/spa
dc.subject.ddc610 - Medicina y salud::612 - Fisiología humanaspa
dc.subject.decsUnidad de cuidados intensivosspa
dc.subject.decsIntensive Care Unitseng
dc.subject.decsTrastornos musculares atróficosspa
dc.subject.decsMuscular Disorders, Atrophiceng
dc.subject.proposalUltrasonografíaspa
dc.subject.proposalMorbilidadspa
dc.subject.proposalMortalidadspa
dc.subject.proposalUnidad de Cuidados Intensivosspa
dc.subject.proposalAtrofia Muscularspa
dc.subject.proposalUltrasonographyeng
dc.subject.proposalMorbidityeng
dc.subject.proposalMortalityeng
dc.subject.proposalIntensive Care Unitseng
dc.subject.proposalMuscular Atrophyeng
dc.titleParámetros de atrofia muscular como predictores de desenlaces clínicos en pacientes de Unidad de Cuidados Intensivosspa
dc.title.translatedParameters of muscle atrophy as predictors of clinical outcomes in intensive care unit patients.eng
dc.typeTrabajo de grado - Maestríaspa
dc.type.coarhttp://purl.org/coar/resource_type/c_bdccspa
dc.type.coarversionhttp://purl.org/coar/version/c_ab4af688f83e57aaspa
dc.type.contentTextspa
dc.type.driverinfo:eu-repo/semantics/masterThesisspa
dc.type.redcolhttp://purl.org/redcol/resource_type/TMspa
dc.type.versioninfo:eu-repo/semantics/acceptedVersionspa
dcterms.audience.professionaldevelopmentEstudiantesspa
dcterms.audience.professionaldevelopmentInvestigadoresspa
dcterms.audience.professionaldevelopmentMaestrosspa
oaire.accessrightshttp://purl.org/coar/access_right/c_abf2spa
oaire.awardtitleCONVOCATORIA NACIONAL PARA EL FOMENTO DE ALIANZAS INTERDISCIPLINARIAS QUE ARTICULEN INVESTIGACIÓN, CREACIÓN, EXTENSIÓN Y FORMACIÓN EN LA UNIVERSIDAD NACIONAL DE COLOMBIA 2019-2022spa
oaire.fundernameDirección Nacional de Investigación y Laboratorios de la Universidad Nacional de Colombiaspa

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