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TEMA: SEPSIS
SEPSIS
13 DE SEPTIEMBRE, DIA MUNDIAL DE LA
SEPSIS
(SEMICYUC)
cdigo sepsis
"Frenar la sepsis salva vidas"
EPIDEMIOLOGIA
Cada 3 latidos, alguien muere de sepsis.
En los pases desarrollados los casos aumentaron 8-13%
anual.
INCIDENCIA
USA:
751.000 casos al ao
mortalidad global 28,6%
Europa occidental:
400-500.000 casos al ao
40%-70% shock sptico
mortalidad del 40%-70%
En Espaa:
Sepsis grave: 104 casos por 100.000 adultos
mortalidad 20,7%
Dra. Beatriz Galvn Guijo
Hospital Universitario La Paz
Departamento de Ciruga UAM,
SEPSIS: Fisiopatologa,
Mediadores, Diagnstico y
Tratamiento.
DEFINICIONE
S
INFECCION
Cuando los grmenes logran traspasar las primeras
barreras defensivas del organismo y se alojan en
tejidos considerados normalmente como estriles,
tiene lugar la infeccin.
Dependiendo de la virulencia del inculo, as como
de la inmunocompetencia del paciente.
La irrupcin de los grmenes al torrente
circulatorio.
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 CareMed. 2001; 29:1303-1310.
NUEVA TERMINOLOGIA
A partir de una conferencia de consenso
celebrada en 1991
Unificar criterios clnicos relacionados con la
respuesta inflamatoria del organismo a la
invasin bacteriana o de diferentes noxas.
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee. Definitions for sepsis and organ failure and guidelines for the use of
innovative therapies in sepsis. Crit Care Med 1992; 20: 864-874.
BACTERIAS
INFECCION FOCAL
BACTEREMIA
EVIDENCIA CLINICA DE INFECCION
MAS:
SEPSIS
SINDROME DE
SEPSIS SEVERA
SINDROME DE SEPSIS, MAS:
SHOCK SEPTICO
TEMPRANO
SEPSIS SEVERA, MAS:
HIPOTENSION A PESAR DE
REPLECION ADECUADA Y
REQUERIMIENTO DE
VASOPRESORES POR MAS
DE 12 H
SHOCK SEPTICO
REFRACTARIO
CUALQUIER COMBINACION DE:
MODS
American College of Chest Physicians/Society of Critical Care Medicine
Consensus Conference Committee. Definitions for sepsis and organ failure and
guidelines for the use of innovative therapies in sepsis
*HIPERTERMIA/HIPOTERMIA
*TAQUICARDIA
*TAQUIPNEA
*LEUCOCITOSIS/LEUCOPENIA
MUERTE
* CID
* SIRPA
* INSUFICIENCIA RENAL
* INSUFICIENCIA HEPATICA AGUDA *
DISFUNCION CEREBRAL AGUDA
Ictericia
Albumin
TP
American College of Chest Physicians/Society of Critical Care Medicine
Consensus Conference Committee. Definitions for sepsis and organ failure
and guidelines for the use of innovative therapies in sepsis
Taquicardia
Hipotensin
CVP
PAOP
Oliguria
Anuria
Creatinina
Platelets
PT/APTT
Protein C
D-dimero
FISIOPATOLOGIA
BACTERIA
MONOCITO
RESPUESTA INFLAMATORIA
HIPERRESPUESTA
(SIRS/SDOM)
RESP.
BALANCEADA
(SIRS/CARS)
HIPO-RESPUESTA
(CARS/SEPSIS)
MUERTE
RESOLUCION
MUERTE
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee. Definitions for sepsis and organ failure and guidelines for the use of innovative
TROMBOSIS
MICROVASCULA
R
HIPOPERFUSIO
N
FISIOPATOLOGIA
EL TRIPODE DE LA
SEPSIS
CASCADA DE
LA
SIRS
COAGULACIO
N
FIBRINOLIS
IS
BLOQUEAD
A
SDOM
ISQUEMIA
LESION TISULAR
CHOQUE
SEPTICO
FOM
SEPSIS SEVERA
MUERTE
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee. Definitions for sepsis and organ failure and guidelines for the use of innovative
TRATAMIENT
O
La sepsis es una
EMERGENCIA MEDICA.
Cada hora de retraso en el
tratamiento, aumenta la
mortalidad
SEMICYUC, Stop sepsis Save Lives, Vincent JL, et al. Sepsis in European intensive care units:. Crit Care Med, 34:344-353, Hyattsville, MD: National Center for Health Statistics.
2011.
SEMICYUC, Stop sepsis Save Lives, Vincent JL, et al. Sepsis in European intensive care units:. Crit Care Med, 34:344-353, Hyattsville, MD: National Center for Health Statistics.
2011.
2) REANIMACIN HEMODINMICA.
SEMICYUC, Stop sepsis Save Lives, Vincent JL, et al. Sepsis in European intensive care units:. Crit Care Med, 34:344-353, Hyattsville, MD: National Center for Health Statistics.
2011.
SEMICYUC, Stop sepsis Save Lives, Vincent JL, et al. Sepsis in European intensive care units:. Crit Care Med, 34:344-353, Hyattsville, MD: National Center for Health Statistics.
2011.
Debilidad neuromuscular
Dolor crnico
Estrs post-traumtico
Deterioro cognitivo
Depresin
SEMICYUC, Stop sepsis Save Lives, Vincent JL, et al. Sepsis in European intensive care units:. Crit Care Med, 34:344-353, Hyattsville, MD: National Center for Health Statistics.
2011.
PREVENCIN
Vacunacin.
Condiciones higinicas.
Programa de educacin.
Cuidado especial a la hora de manipular vas
intravenosas, sondas o drenajes.
SEMICYUC, Stop sepsis Save Lives, Vincent JL, et al. Sepsis in European intensive care units:. Crit Care Med, 34:344-353, Hyattsville, MD: National Center for Health Statistics.
2011.
SEMICYUC, Stop sepsis Save Lives, Vincent JL, et al. Sepsis in European intensive
care units:. Crit Care Med, 34:344-353, Hyattsville, MD: National Center for Health
SEMICYUC, Stop sepsis Save Lives, Vincent JL, et al. Sepsis in European intensive care units:. Crit Care Med, 34:344-353, Hyattsville, MD: National Center for Health Statistics. 2011.
Mortalidad
< 20%
GRACIAS POR SU