ABSTRACT 814

Abstract

Background and aims: WHO based protocol and the Pediatric Advanced Life Support approach have been used for the treatment of hypovolemic shock in Guatemala City. WHO is based in clinical findings and do not has any goal in the treatment. Aims: Identifies if in patients with severe hypovolemia, ischemia, metabolic acidosis and with absence of central pulses the fluid deficit will be higher and underestimated. Methods: Prospective, descriptive, University Hospital, hypovolemic shock related to diarrhea. Rapid cardiopulmonary evaluation of the PALS course was performed, Blood lactate was measured 0 min and 60 min after starting the fluid recovery. The goal directed therapy restore pulses, extremities warmth, capillary refill < 2 seconds, heart rate decrease, and increase in blood pressure. Monitoring for the appearance of congestive rales, hepatomegaly after the hydratation, severe edema or increment of the intrabdominal pressure. Decisions were based in perfusion restoration instead of the WHO protocol. Data processed SPSS 22;a t test for independent samples with a significant value of p < 0.05. Results: 82 children, age of 21.5 ± 34.5 months, 57 survived and 25 died. All decreased mental status. Survivors had lower HR at admission and 1 hour after, (p<0.05), higher MAP, higher pH (p<0.001), lower lactate. higher lactate depuration and base excess correction (p<0.001) All the nutritional indexes were lower in patients who died (p<0.05). Conclusions: Survivors received in the first hour 97.7 ± 42.2 ml/kg, this represents 49% more than the recommendations of the WHO protocol (p<0.001).