Gómez RN, García ZMG, Fonseca CI, Villalobos GL, Cano RMA, Vázquez PE, Molina MFA, Contreras SJ

Language: Spanish
References: 24
Page: 215-220
PDF size: 103.93 Kb.

ABSTRACT

Objective: To compare the differences in treatment efficiency between two handling approaches for hemodynamic stabilization of patients in septic shock in a 24 hour period.
Material and procedures: Design cross-sectional/comparative.
Group 1: We selected 23 clinical cases that meet the inclusion criteria for patients diagnosed with septic shock and who were treated based on a therapeutic guide that recommends the use of noradrenaline as a vasopressor agent and the use of hydrocortisone for hemodynamic stabilization. Group 2 it was composed by 24 patients who met the inclusion criteria for cases treated for a septic shock diagnosis and who had been exposed to a therapeutic guide that recommends the use of dopamine as a vasopressor agent and that does not support the use of hydrocortisone for hemodynamic stabilization. Both groups were treated in the Service of Urgencies and Hospitalization of the Infantil Hospital del Estado de Sonora.
Results: Clinical recovery of state of shock: group 1, 75%; group 2, 41% (p = 0.0009). Average Value of PVC (mmHg): group 1, 8.725; group 2, 7.636 (p = 0.08108). Average PAM (mmHg): group 1, 84.16 ± 6.66; Group 2, 81.31 ± 9.47 (P = 0.0951). Average value of seum pH: group 1, 7.37; group 2, 7.29 (p = 0.0437). Urinary waste (mL/kg/h): Group 1, 4.71; group 2: 1.86, (p 0.0020). Death rate: group 1, 9 cases; group 2, 12 cases (0. 064).
Conclusions: The handling protocol for group 1 showed better results. Clinical recovery of the state of shock, urinary waste and stabilization of the acid-base balance were better for group 1 than they were for group 2. There were no differences between either group in PAM correction and death rate.

REFERENCES

1. Sakr Y, Dubois MJ, De Backer D et al. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med 2004;32:1825-31.

2. Beloeil H, Mazoit J, Benhamou D. Norepinephrine kinetics and dynamics in septic shock and trauma patients. Br J Anaesth 2005;95:782-90.

3. Seguin P, Bellissant E, Le Tulzo Y et al. Effects of epinephrine compared with the combination of dobutamine and norepinephrine on gastric perfusion in septic shock. Clin Pharmacol Ther 2002;71:381-8.

4. Zhang H, Smail N, Cabral A, Rogiers P, Vincent JL. Effects of norepinephrine on regional blood flow and oxygen extraction capabilities during endotoxic shock. Am J Resp Crit Care Med 1997;155:1965-71.

5. Schein RMH, Sprung CL, Marcial E et al. Plasma cortisol levels in patients with septic shock. Crit Care Med 2003;18:259-63.

6. Palencia E. CORTICUS: Hidrocortisona en el shock séptico. [REMI 2006;6(10):A56].

7. Djillali A, Virginie M, Fidaa I, Jean C, Emuri A, Philippe B. Diagnosis of adrenal insufficiency in severe sepsis and septic shock. Am J Respir Crit Care Med 2006;174:1319-26.

8. Martínez-Franco M, Domínguez-Cherit G, Rivero-Sigarroa E. Función suprarrenal en pacientes críticamente enfermos. Rev Asoc Mex Med Crit y Ter Int 2004;18 (1):11-16.

9. Martin C, Viviand X, Leone M et al. Effect of norepinephrine on the outcome of septic shock. Crit Care Med 2000;28:2758-65.

10. Bellomo R, Chapman M, Finfer S et al. Lowdose dopamine in patients with early renal dysfunction: A placebo-controlled randomized trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet 2000;356:2139-43.

11. Ruokonen E, Takala J, Kari A. Regional blood flow and oxygen transport in patients with the low cardiac output syndrome after cardiac surgery. Crit Care Med 1993;21: 1304-11.

12. Dellinger RP, Carlet JM, Masur H et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858-73.

13. Hollenberg SM, Ahrens TS, Annane D et al. Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 2004;32:1928-48.

14. Sakr Y, Reinhart K, Jean-Louis V. Does dopamine administration in shock influence outcome? Results of the sepsis occurrence in acutely ill Patients (SOAP). Crit Care Med 2006;34(3) (faltan pp.)

15. Lefering R, Neugebauer EAM. Steroid controversy in sepsis and septic shock: a meta-analysis. Crit Care Med 1995;23:1294-303.

16. Blas-Macedo J. Esteroides en sepsis y choque séptico. Un encuentro con ritos del pasado. Rev Asoc Mex 2002;16(2):58-16.

17. Takakura K, Taniguchi T, Muramatsu I et al. As a possible mechanism of systemic hypotension in sepsis. Crit Care Med 2002;30:894-9.

18. Briegel J, Frost H, Haller M et al. Stress doses hydrocortisone reverse hyperdignamic septic shock: a prospective, randomized, double blind single center study. Crit Care Med 1999;27:723-32.

19. Annaned D, Sakka SG, Reinhart K, Wegscheider K et al. Corticosteroids for septic shock. Variability of splanchnic blood flow in patients with sepsis. Intensive Care Med 2001;27:1281-7.

20. Oppert M, Schindler R, Husung C, Offermann. Low-dose hydrocortisone improves shock reversal and reduces cytokine levels in early hyperdynamic septic shock. Critical Care Medicine 2005;33(11):2457-64.

21. Hatherill M, Tibby SM, Hillard T et al. Adrenal insufficiency in septic shock. Arch Dis Child 1999;80:51-60.

22. Rivers E, Nguyen B, Havstad S et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77.

23. Dellinger RP. Cardiovascular management of septic shock. Crit Care Med 2003;31(3): 946-55.

24. Patel GP et al. New treatment strategies for severe sepsis and septic shock. Current Opinion in Critical Care 2003;9:390-6.