Estrategia de reanimación temprana guiada por metas para el manejo del paciente con sepsis
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jul 1, 2021
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Resumen
La sepsis y el choque séptico son condiciones asociadas con una alta incidencia y mortalidad. Por lo tanto, la identificación e intervención temprana permite mejorar los desenlaces. El método para desarrollar esta identificación e intervención se ha plasmado en el desarrollo de guías de atención. Dentro de estas guías destaca el concepto de Estrategia de Reanimación Temprana Guiada por Metas (ERTGM), el cual tiene su base operativa en el estudio de Rivers a comienzo de este siglo. Aunque estudios subsecuentes refutan esta estrategia en particular, el concepto de ERTGM persiste en las guías de la campaña Surviving Sepsis y en el actuar clínico actual. Ha medida que el conocimiento medico ha venido avanzando se ha abandonado la mayoría de las metas estáticas y avanzando en la importancia del inicio temprano de líquidos y antibiótico, la normalización del lactato y la valoración continua del paciente dentro de una atención individualizada del paciente.
Keywords
Reanimación guiada por metas, Sepsis, Choque séptico, lactato, líquidosEarly Goal Directed Therapy, Sepsis, Septic Shock, Lactate, Fluids
References
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2. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020. doi:10.1016/S0140-6736(19)32989-7
3. Mouncey PR, Osborn TM, Power GS, Harrison. National inpatient hospital costs: The most expensive conditions by Payer, 2011. N Engl J Med. 2014. doi:10.1056/NEJMoa1500896
4. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017. doi:10.1007/s00134-017-4683-6
5. Nguyen HB, Jaehne AK, Jayaprakash N, et al. Early goal-directed therapy in severe sepsis and septic shock: Insights and comparisons to ProCESS, ProMISe, and ARISE. Crit Care. 2016. doi:10.1186/s13054-016-1288-3
6. 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. doi:10.1056/NEJMoa010307
7. Rady MY, Rivers EP, Nowak RM. Resuscitation of the critically ill in the ED: Responses of blood pressure, heart rate, shock index, central venous oxygen saturation, and lactate. Am J Emerg Med. 1996. doi:10.1016/S0735-6757(96)90136-9
8. Cortez A, Zito J, Lucas CE, Gerrick SJ. Mechanism of Inappropriate Polyuria in Septic Patients. Arch Surg. 1977. doi:10.1001/archsurg.1977.01370040123019
9. Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004. doi:10.1097/01.CCM.0000117317.18092.E4
10. Yealy DM, Kellum JA, Huang DT, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014. doi:10.1056/NEJMoa1401602
11. Dellinger RP, Levy MM, Carlet JM, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008. doi:10.1097/01.CCM.0000298158.12101.41
12. Peake SL, Delaney A, Bailey M, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014. doi:10.1056/NEJMoa1404380
13. Peake SL, Bailey M, Bellomo R, et al. Australasian resuscitation of sepsis evaluation (ARISE): A multi-centre, prospective, inception cohort study. Resuscitation. 2009. doi:10.1016/j.resuscitation.2009.03.008
14. Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015. doi:10.1056/NEJMoa1500896
15. Rowan KM, Angus DC, Bailey M, et al. Early, goal-directed therapy for septic shock - A patient-level meta-analysis. N Engl J Med. 2017. doi:10.1056/NEJMoa1701380
16. Walkey AJ, Wiener RS. Hospital case volume and outcomes among patients hospitalized with severe sepsis. Am J Respir Crit Care Med. 2014. doi:10.1164/rccm.201311-1967OC
17. Dellinger RP, Levy M, Rhodes A, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013. doi:10.1097/CCM.0b013e31827e83af
18. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. In: Critical Care Medicine. ; 2003. doi:10.1097/01.CCM.0000050454.01978.3B
19. Broder G, Weil MH. Excess lactate: An index of reversibility of shock in human patients. Science (80- ). 1964. doi:10.1126/science.143.3613.1457
20. Weil MH, Afifi AA. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation. 1970. doi:10.1161/01.CIR.41.6.989
21. PERETZ DI, MCGREGOR M, DOSSETOR JB. LACTICACIDOSIS: A CLINICALLY SIGNIFICANT ASPECT OF SHOCK. Can Med Assoc J. 1964.
22. Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013. doi:10.1056/NEJMra1208943
23. Levy B. Lactate and shock state: The metabolic view. Curr Opin Crit Care. 2006. doi:10.1097/01.ccx.0000235208.77450.15
24. Nichol AD, Egi M, Pettila V, et al. Relative hyperlactatemia and hospital mortality in critically ill patients: A retrospective multi-centre study. Crit Care. 2010. doi:10.1186/cc8888
25. Vincent JL, Dufaye P, Berre J, Leeman M, Degaute JP, Kahn RJ. Serial lactate determinations during circulatory shock. Crit Care Med. 1983. doi:10.1097/00003246-198306000-00012
26. Orringer CE, Eustace JC, Wunsch CD, Gardner LB. Natural History of Lactic Acidosis after Grand-Mal Seizures. N Engl J Med. 1977. doi:10.1056/nejm197710132971502
27. Vincent JL, e Silva AQ, Couto L, Taccone FS. The value of blood lactate kinetics in critically ill patients: A systematic review. Crit Care. 2016. doi:10.1186/S13054-016-1403-5
28. Jansen TC, Van Bommel J, Schoonderbeek FJ, et al. Early lactate-guided therapy in intensive care unit patients: A multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010. doi:10.1164/rccm.200912-1918OC
29. Hernandez G, Bellomo R, Bakker J. The ten pitfalls of lactate clearance in sepsis. Intensive Care Med. 2019. doi:10.1007/s00134-018-5213-x
30. Levy MM, Dellinger RP, Townsend SR, et al. The surviving sepsis campaign: Results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med. 2010. doi:10.1007/s00134-009-1738-3
31. Levy MM, Rhodes A, Phillips GS, et al. Surviving sepsis campaign: Association between performance metrics and outcomes in a 7.5-year study. Crit Care Med. 2015. doi:10.1097/CCM.0000000000000723
32. Frazee E, Kashani K. Fluid Management for Critically Ill Patients: A Review of the Current State of Fluid Therapy in the Intensive Care Unit. Kidney Dis. 2016. doi:10.1159/000446265
33. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? Chest. 2008. doi:10.1378/chest.07-2331
34. Shippy CR, Appel PL, Shoemaker WC. Reliability of clinical monitoring to assess blood volume in critically ill patients. Crit Care Med. 1984. doi:10.1097/00003246-198402000-00005
35. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: A critical analysis of the evidence. Chest. 2002. doi:10.1378/chest.121.6.2000
36. Monnet X, Rienzo M, Osman D, et al. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med. 2006. doi:10.1097/01.CCM.0000215453.11735.06
37. Monnet X, Marik P, Teboul JL. Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis. Intensive Care Med. 2016. doi:10.1007/s00134-015-4134-1
38. Monnet X, Marik PE, Teboul JL. Prediction of fluid responsiveness: an update. Ann Intensive Care. 2016. doi:10.1186/s13613-016-0216-7
39. LeDoux D, Astiz ME, Carpati CM, Rackow EC. Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med. 2000. doi:10.1097/00003246-200008000-00007
40. Bourgoin A, Leone M, Delmas A, Garnier F, Albanèse J, Martin C. Increasing mean arterial pressure in patients with septic shock: Effects on oxygen variables and renal function. Crit Care Med. 2005. doi:10.1097/01.CCM.0000157788.20591.23
41. Thooft A, Favory R, Salgado DR, et al. Effects of changes in arterial pressure on organ perfusion during septic shock. Crit Care. 2011. doi:10.1186/cc10462
42. Duveau A, Augusto JF, Gilet C, Asfar P. SEPSISPAM: Effects of two levels of blood pressure on survival in patients with septic shock. Reanimation. 2011. doi:10.1007/s13546-011-0221-7
43. Barochia A V., Cui X, Eichacker PQ. The surviving sepsis campaign’s revised sepsis bundles. Curr Infect Dis Rep. 2013. doi:10.1007/s11908-013-0351-3
44. Marik PE, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy. Ann Intensive Care. 2011. doi:10.1186/2110-5820-1-1
45. Osman D, Ridel C, Ray P, et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med. 2007. doi:10.1097/01.CCM.0000249851.94101.4F
46. Jozwiak M, Monnet X, Teboul JL. Implementing sepsis bundles. Ann Transl Med. 2016. doi:10.21037/atm.2016.08.60
47. Acheampong A, Vincent JL. A positive fluid balance is an independent prognostic factor in patients with sepsis. Crit Care. 2015. doi:10.1186/s13054-015-0970-1
48. Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluid resuscitation in septic shock: A positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011. doi:10.1097/CCM.0b013e3181feeb15
49. Bai X, Yu W, Ji W, et al. Early versus delayed administration of norepinephrine in patients with septic shock. Crit Care. 2014. doi:10.1186/s13054-014-0532-y
50. Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Crit Care Med. 2018. doi:10.1097/CCM.0000000000003119
2. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020. doi:10.1016/S0140-6736(19)32989-7
3. Mouncey PR, Osborn TM, Power GS, Harrison. National inpatient hospital costs: The most expensive conditions by Payer, 2011. N Engl J Med. 2014. doi:10.1056/NEJMoa1500896
4. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017. doi:10.1007/s00134-017-4683-6
5. Nguyen HB, Jaehne AK, Jayaprakash N, et al. Early goal-directed therapy in severe sepsis and septic shock: Insights and comparisons to ProCESS, ProMISe, and ARISE. Crit Care. 2016. doi:10.1186/s13054-016-1288-3
6. 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. doi:10.1056/NEJMoa010307
7. Rady MY, Rivers EP, Nowak RM. Resuscitation of the critically ill in the ED: Responses of blood pressure, heart rate, shock index, central venous oxygen saturation, and lactate. Am J Emerg Med. 1996. doi:10.1016/S0735-6757(96)90136-9
8. Cortez A, Zito J, Lucas CE, Gerrick SJ. Mechanism of Inappropriate Polyuria in Septic Patients. Arch Surg. 1977. doi:10.1001/archsurg.1977.01370040123019
9. Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004. doi:10.1097/01.CCM.0000117317.18092.E4
10. Yealy DM, Kellum JA, Huang DT, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014. doi:10.1056/NEJMoa1401602
11. Dellinger RP, Levy MM, Carlet JM, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008. doi:10.1097/01.CCM.0000298158.12101.41
12. Peake SL, Delaney A, Bailey M, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014. doi:10.1056/NEJMoa1404380
13. Peake SL, Bailey M, Bellomo R, et al. Australasian resuscitation of sepsis evaluation (ARISE): A multi-centre, prospective, inception cohort study. Resuscitation. 2009. doi:10.1016/j.resuscitation.2009.03.008
14. Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015. doi:10.1056/NEJMoa1500896
15. Rowan KM, Angus DC, Bailey M, et al. Early, goal-directed therapy for septic shock - A patient-level meta-analysis. N Engl J Med. 2017. doi:10.1056/NEJMoa1701380
16. Walkey AJ, Wiener RS. Hospital case volume and outcomes among patients hospitalized with severe sepsis. Am J Respir Crit Care Med. 2014. doi:10.1164/rccm.201311-1967OC
17. Dellinger RP, Levy M, Rhodes A, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013. doi:10.1097/CCM.0b013e31827e83af
18. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. In: Critical Care Medicine. ; 2003. doi:10.1097/01.CCM.0000050454.01978.3B
19. Broder G, Weil MH. Excess lactate: An index of reversibility of shock in human patients. Science (80- ). 1964. doi:10.1126/science.143.3613.1457
20. Weil MH, Afifi AA. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation. 1970. doi:10.1161/01.CIR.41.6.989
21. PERETZ DI, MCGREGOR M, DOSSETOR JB. LACTICACIDOSIS: A CLINICALLY SIGNIFICANT ASPECT OF SHOCK. Can Med Assoc J. 1964.
22. Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013. doi:10.1056/NEJMra1208943
23. Levy B. Lactate and shock state: The metabolic view. Curr Opin Crit Care. 2006. doi:10.1097/01.ccx.0000235208.77450.15
24. Nichol AD, Egi M, Pettila V, et al. Relative hyperlactatemia and hospital mortality in critically ill patients: A retrospective multi-centre study. Crit Care. 2010. doi:10.1186/cc8888
25. Vincent JL, Dufaye P, Berre J, Leeman M, Degaute JP, Kahn RJ. Serial lactate determinations during circulatory shock. Crit Care Med. 1983. doi:10.1097/00003246-198306000-00012
26. Orringer CE, Eustace JC, Wunsch CD, Gardner LB. Natural History of Lactic Acidosis after Grand-Mal Seizures. N Engl J Med. 1977. doi:10.1056/nejm197710132971502
27. Vincent JL, e Silva AQ, Couto L, Taccone FS. The value of blood lactate kinetics in critically ill patients: A systematic review. Crit Care. 2016. doi:10.1186/S13054-016-1403-5
28. Jansen TC, Van Bommel J, Schoonderbeek FJ, et al. Early lactate-guided therapy in intensive care unit patients: A multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010. doi:10.1164/rccm.200912-1918OC
29. Hernandez G, Bellomo R, Bakker J. The ten pitfalls of lactate clearance in sepsis. Intensive Care Med. 2019. doi:10.1007/s00134-018-5213-x
30. Levy MM, Dellinger RP, Townsend SR, et al. The surviving sepsis campaign: Results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med. 2010. doi:10.1007/s00134-009-1738-3
31. Levy MM, Rhodes A, Phillips GS, et al. Surviving sepsis campaign: Association between performance metrics and outcomes in a 7.5-year study. Crit Care Med. 2015. doi:10.1097/CCM.0000000000000723
32. Frazee E, Kashani K. Fluid Management for Critically Ill Patients: A Review of the Current State of Fluid Therapy in the Intensive Care Unit. Kidney Dis. 2016. doi:10.1159/000446265
33. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? Chest. 2008. doi:10.1378/chest.07-2331
34. Shippy CR, Appel PL, Shoemaker WC. Reliability of clinical monitoring to assess blood volume in critically ill patients. Crit Care Med. 1984. doi:10.1097/00003246-198402000-00005
35. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: A critical analysis of the evidence. Chest. 2002. doi:10.1378/chest.121.6.2000
36. Monnet X, Rienzo M, Osman D, et al. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med. 2006. doi:10.1097/01.CCM.0000215453.11735.06
37. Monnet X, Marik P, Teboul JL. Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis. Intensive Care Med. 2016. doi:10.1007/s00134-015-4134-1
38. Monnet X, Marik PE, Teboul JL. Prediction of fluid responsiveness: an update. Ann Intensive Care. 2016. doi:10.1186/s13613-016-0216-7
39. LeDoux D, Astiz ME, Carpati CM, Rackow EC. Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med. 2000. doi:10.1097/00003246-200008000-00007
40. Bourgoin A, Leone M, Delmas A, Garnier F, Albanèse J, Martin C. Increasing mean arterial pressure in patients with septic shock: Effects on oxygen variables and renal function. Crit Care Med. 2005. doi:10.1097/01.CCM.0000157788.20591.23
41. Thooft A, Favory R, Salgado DR, et al. Effects of changes in arterial pressure on organ perfusion during septic shock. Crit Care. 2011. doi:10.1186/cc10462
42. Duveau A, Augusto JF, Gilet C, Asfar P. SEPSISPAM: Effects of two levels of blood pressure on survival in patients with septic shock. Reanimation. 2011. doi:10.1007/s13546-011-0221-7
43. Barochia A V., Cui X, Eichacker PQ. The surviving sepsis campaign’s revised sepsis bundles. Curr Infect Dis Rep. 2013. doi:10.1007/s11908-013-0351-3
44. Marik PE, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy. Ann Intensive Care. 2011. doi:10.1186/2110-5820-1-1
45. Osman D, Ridel C, Ray P, et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med. 2007. doi:10.1097/01.CCM.0000249851.94101.4F
46. Jozwiak M, Monnet X, Teboul JL. Implementing sepsis bundles. Ann Transl Med. 2016. doi:10.21037/atm.2016.08.60
47. Acheampong A, Vincent JL. A positive fluid balance is an independent prognostic factor in patients with sepsis. Crit Care. 2015. doi:10.1186/s13054-015-0970-1
48. Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluid resuscitation in septic shock: A positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011. doi:10.1097/CCM.0b013e3181feeb15
49. Bai X, Yu W, Ji W, et al. Early versus delayed administration of norepinephrine in patients with septic shock. Crit Care. 2014. doi:10.1186/s13054-014-0532-y
50. Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Crit Care Med. 2018. doi:10.1097/CCM.0000000000003119
Cómo citar
Lombo Moreno, C. E. (2021). Estrategia de reanimación temprana guiada por metas para el manejo del paciente con sepsis. Universitas Medica, 62(3). https://doi.org/10.11144/Javeriana.umed62-3.ertg
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