Salcedo RC, Villarreal PPR, Agramonte VN

Language: Spanish
References: 17
Page:
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ABSTRACT

Background: severe sepsis and septic shock are one of the causes of morbidity and mortality in the pediatric population worldwide. There has been an increase in patients admitted with these stages of sepsis in recent years in the Pediatric Intensive Care Unit of Sancti Spíritus. Objective: to describe the clinical and epidemiological characteristics of severe sepsis and septic shock in the Pediatric Intensive Care Unit of Sancti Spíritus from 2005 to 2008. Methodology: a retrospective study of patients admitted to the Pediatric Intensive Care Unit of Sancti Spíritus with severe sepsis and septic shock in the studied period with the variables age, sex, risk factors for sepsis, place of reference to the Intensive Care Unit, stage of sepsis, targeting, multiple organ dysfunction, used treatment and discharge status. Results: 32 patients were admitted with severe sepsis stadium and septic shock (43.9 %); most affected were children under one year (62.5 %), less than 3 months (37.5 %) and underlying chronic illness (37.5 %). 90.6 % were referred from the emergency rooms. The focus of infection in the respiratory, gastrointestinal apparatus and unfocused infection prevailed. Most of the patients received fluid between 20 and 40 ml/kg in the first hour, the use of antibiotics and vasoactive drugs was appropriate. 75 % progressed to multiorgan dysfunction and 46.88 % died, this accounted for 27.8 % of hospital mortality. Conclusions: the mortality from severe sepsis and septic shock is high, die 1 for each 2.1 patients.

REFERENCES

1. Montalván González G. Shock séptico en pediatría: un acercamiento a su manejo. Rev Cubana Pediatr[Internet]. 2008 ene-mar[citada: 24 Mar 2013]; 80 (1). Available from: http://scielo.sld.cu/scielo.php?pid=S0034-75312008000100008&script=sci_arttext

2. Andrejaitiene J. The diagnostic value of procalcitonin in severe sepsis. Medicina (Kaunas) [Internet]. 2006[citada: 24 Mar 2013];42(1):69-78. Available from: http://medicina.lsmuni.lt/med/0601/0601-10l.pdf

3. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome and associated costs of care. Crit Care Med[Internet]. 2001 Jul[citada: 24 Mar 2013];29(7):1303-10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11445675

4. Scott Watson R, Carcillo JA. Scope and epidemiology of pediatric sepsis. Pediatr Crit Care Med[Internet]. 2005 May[citada: 24 Mar 2013];6(3 Suppl):S3-5. Available from: http://journals.lww.com/pccmjournal/pages/articleviewer.aspx?year=2005&issue=05001&article=00002&type=abstract

5. Wolfler A, Silvani P, Musicco M. Incidence of and mortality due to sepsis, severe sepsis and septic shock in Italian Pediatric Intensive Care Units: a prospective national survey. Intensive Care Med[Internet]. 2008 Sep[citada: 24 Mar 2013];34(9):1690-7. Available from: http://link.springer.com/article/10.1007%2Fs00134-008-1148-y

6. Padkin A, Goldfrad C, Brady AR, Yong D. Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland. Crit Care Med[Internet]. 2003 Sep[citada: 24 Mar 2013];31(9):2332-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/?term=Epidemiology+of+severe+sepsis+occurring+in+the+first+24+hrs+in+intensive+care+units+in+England%2C+Wales%2C+and+Northern+Ireland.+Crit+Care+Med.+2003+S

7. González Velásquez A, Valdés Armas F. Comportamiento de la sepsis en terapia intensiva pediátrica. Rev Cub Med Int Emerg[Internet]. 2007[citada: 24 Mar 2013];6(3):857-870. Disponible en: http://bvs.sld.cu/revistas/mie/vol6_3_07/mie08307.htm

8. Vincent JL, Abraham E. The Last 100 Years of Sepsis. Am J Respir Crit Care Med[Internet]. 2006 Feb [citada: 24 Mar 2013];173(3):256-63. Available from: http://www.atsjournals.org/doi/abs/10.1164/rccm.200510-1604OE?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed&

9. Martin Greg, Mannino DM. The epidemiology of Sepsis in the United States from 1979 through 2000. N Engl J Med[Internet]. 2003 Apr[citada: 24 Mar 2013];348(16):1546-54. Available from: http://www.ncbi.nlm.nih.gov/pubmed/?term=The+epidemiology+of+Sepsis+in+the+United+States+from+1979+through+2000.+New+England+Journal+of+Medicine+2003

10. Khwannimit B, Bhurayanontachai R. The Epidemiology of, and Risk factors for, mortality from Severe sepsis and Septic shock in a tertiary care university hospital setting. Epidemiol Infect[Internet]. 2009 Sep[citada: 24 Mar 2013];137(9):1333-41. Available from: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=5978584&fileId=S0950268809002027

11. Watson R, Carcillo JA. The Epidemiology of Severe Sepsis in children in the United States. Am J Respir Crit Care Med[Internet]. 2003 Mar[citada: 24 Mar 2013];167(5):695-701. Available from: http://www.atsjournals.org/doi/abs/10.1164/rccm.200207-682OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

12. Carcillo JA, Fields Al. Task Force Committee Members. Clinical practice parameters for hemodynamic support of padiatric and neonatal patients in septic shock. Crit Care Med[Internet]. 2002[citada: 24 Mar 2013]; 30: 1365-78. http://journals.lww.com/ccmjournal/pages/articleviewer.aspx?year=2002&issue=06000&article=00040&type=abstract

13. Kumar A, Roberts D. Duration o hypotention before initiation of effective antimicrobial therapy is the critical determinant of survival in human Septic shock. Crit Care Med[Internet]. 2006 Jun[citada: 24 Mar 2013];34(6):1589-96. Available from: http://www.ncbi.nlm.nih.gov/pubmed/?term=Duration+o+hypotention+before+initiation+of+effective+antimicrobial+therapy+is+the+critical+determinant+of+survival+in+human+Septic+shock.+Crit+Care+Med+2006

14. Goldstain B, Girorir B, Randolph A. Internatinal Pediatric Sepsis Consensus Conference : Definitions for Sepsis and organ dysfunction in Pediatrics. Pediatr Crit Care Med[Internet]. 2005 Jan[citada: 24 Mar 2013];6(1):2-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15636651

15. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008[citada: 24 Mar 2013]. Crit Care Med[Internet]. 2008 Jan;36(1):296-327. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18158437

16. Oliveira CF, Nogueira de Sá FR, Oliveira DS, Gottschald AF, Moura JD, Shibata AR, et al. Time- and fluid-sensitive resuscitation for hemodynamic support of children in septic shock: barriers to the implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support Guidelines in a pediatric intensive care unit in a developing world. Pediatr Emerg Care[Internet]. 2008 Dec[citada: 24 Mar 2013];24(12):810-5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/?term=Time+and+Fluid+sensitive+resuscitation+for+hemodynamic+support+of+children+in+septic+shock.+Pediatr+Emerg+Care.+2008+Dec

17. Crespo Barrios AI, Cruz Álvarez CI, Álvarez Montalvo D. Mortalidad por Sepsis en UCIP. Hospital pediátrico Juan Manuel Márquez 2002-2005. IV Congreso Internacional URGRAV. La Habana: Hospital Pediátrico Juan Manuel Márquez; 2006.