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Boletín Médico del Hospital Infantil de México

2013, Número 4

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Bol Med Hosp Infant Mex 2013; 70 (4)


Choque séptico. Actualización en la monitorización hemodinámica

Arriagada D, Donoso A, Cruces P, Díaz F

Idioma: Español
Referencias bibliográficas: 58
Paginas: 273-282
Archivo PDF: 214.56 Kb.


RESUMEN

Si bien los principios básicos para el diagnóstico y la monitorización hemodinámica como los pilares terapéuticos del niño con choque séptico se mantienen en el tiempo, es innegable que en las últimas décadas se han incorporado nuevos y trascendentes conceptos, por lo que es importante que el médico tratante de las unidades de cuidados intensivos tenga conocimiento de ellos a cabalidad.
La monitorización hemodinámica es una herramienta que no solamente permite detectar el origen de la inestabilidad hemodinámica sino también guiar el tratamiento y evaluar su efectividad. La resucitación con fluidos debe ser el primer paso en la reanimación del paciente hemodinámicamente inestable. Sin embargo, la determinación clínica del volumen intravascular puede ser, en ocasiones, difícil de establecer en el paciente crítico. Las presiones de llenado cardiaco no son capaces de predecir la respuesta a fluidos. Los indicadores dinámicos de respuesta a fluidos evalúan el cambio en el volumen eyectivo durante la ventilación mecánica; de este modo, se valora la curva de Frank-Starling del paciente. Mediante la prueba de fluido es posible evaluar el grado de la reserva de precarga que se puede utilizar para aumentar el volumen eyectivo.
En esta revisión se actualiza la información disponible sobre la monitorización hemodinámica básica y funcional.


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