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III Consenso Internacional de Sepsis y Shock Séptico 2016

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Resumen presentado en diapositivas del III Consenso Internacional de Sepsis y Shock Séptico. Presentando los nuevos conceptos de estos.

Published in: Health & Medicine
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III Consenso Internacional de Sepsis y Shock Séptico 2016

  1. 1. III CONSENSO INTERNACIONAL DE SEPSIS Y SHOCK SEPTICO-2016 The European Society of Intensive Care Medicine and the Society of Critical Care Medicine
  2. 2. DEFICIENCIAS DEL MODELO DE 2001 • Enfoque excesivo en inflamación. • Confusa continuación de sepsis severa a shock séptico. • Criterios de SIRS con baja sensibilidad y especificidad. • Discrepancias de incidencia y mortalidad. • El término sepsis severa es redundante.
  3. 3. MARCO GENERAL SEPSIS Alteración Fisiológica Alteración Patológica Alteración Bioquímica INFECCIÓN  Incremento de la incidencia (envejecimiento poblacional?).  Sepsis como causa importante de mortalidad y enfermedad critica a nivel mundial.  Personas que sobreviven a Sepsis tiene a largo plazo discapacidad física, psicológica y cognitiva. Necesidad de revisión de los criterios y definiciones de Sepsis.
  4. 4. SEPSIS 1991 Sepsis resulta de una respuesta inflamatoria sistémica(SIRS) a la infección. Si a esto se le añade una disfunción orgánica recibe el nombre de SEPSIS SEVERA, si a esto se le añade hipotensión refractaria a fluidoterapia llegaría ser SHOCK SEPTICO. REUNIONES PASADAS SEPSIS 2001 En esta reunión se discutieron limitaciones con las definiciones, expandieron la lista de criterios diagnósticos. Se tenia un problema de poca evidencia de éstos.
  5. 5. Se juntaron 19 expertos de diferentes especialidades de The European Society of Intensive Care Medicine and the Society of Critical Care Medicine, los representantes fueron Dr. Deutschman y Dr. Singer. Las reuniones se dieron de Enero del 2014 hasta Enero de 2015. Usando historiales médicos y estudios de Cohorte.
  6. 6. CONCEPTOS SEPSIS 2001 SEPSIS: Respuesta multifacética a un agente infeccioso que puede ser amplificado por factores endógenos, sepsis como infección con al menos 2 o 4 criterios SIRS(enfocándose solo en exceso de inflamación). *Los criterios SIRS no necesariamente indican respuesta desregulada. Pobre validez discriminativa. Pobre validez concurrente. SEPSIS 2016 SEPSIS: Disfunción orgánica que amenaza la vida causada por una respuesta desregulada a la infección. Existe también activación temprana de mediadores pro y antiinflamatorios así dañando sus propios órganos y tejidos dando alteraciones no inmunológicas (cardiovascular, neuronal, hormonal, metabólica y coagulación). Disfunción organiza no se relaciona a muerte celular.
  7. 7.  SEXO  RAZA  GENÉTICA  EDAD  COMORBILIDADES  MEDICACIÓN MODIFICAN INFECCIÓN = Respuesta Regulada SEPSIS = Respuesta Desregulada + Disfunción Orgánica *Considerar disfunción orgánica en pacientes con infección. *Infecciones especificas pueden resultar en disfunción orgánica sin respuesta desregulada sistémica.
  8. 8. DISFUNCIÓN O FALLA ORGANICA El que actualmente se usa es SOFA(Sequential [Sepsis-Related] Organ Failure Assessment Score) por ser el mas común, puntuaciones altas están en relación a una alta mortalidad. Este Score evalúa varios parámetros. El nuevo modelo qSOFA(quick SOFA) es un criterio simple que ayuda a la sospecha de disfunción orgánica y tomar decisiones. Tiene la ventaja de no necesitar pruebas de laboratorio y la rapidez de su uso. También ayuda a la sospecha de posible infección en pacientes sin sospecha previa. SOFA ≥2 tiene riesgo de mortalidad 10% en pacientes con sospecha de infección.
  9. 9. SHOCK SÉPTICO Es definido como un subconjunto de sepsis en donde el Sistema circulatorio y las anormalidades del metabolismo celular son suficientes para incrementar la mortalidad 2001-Shock séptico: Falla circulatoria aguda. 2016-Shock séptico: Diferenciar al Shock séptico de la disfunción cardiovascular por si sola y considerar anormalidades celulares. SHOCK SEPTICO:  Refractario a fluidoterapia  Sepsis  Vasopresores(para mantener PAM≥65 mmHg.)  lactato >2 mmol/l. (indica disfunción celular) *La asociación de Hipotensión y lactato elevado indican juntas una disfunción celular y cardiovascular y se asocia a alta mortalidad. >40% mortalidad !La primera causa de muerte en personas con infección es la SEPSIS!
  10. 10. *Si no esta disponible medir el lactato usar un criterio de hipoperfusión tisular(retardo de llenado capilar) si es necesario.

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