Notas actuais sobre a fluidoterapia na sépsis. O papel da ecocardiografia e dos parâmetros dinâmicos
Palavras-chave:
fluidoterapia, sépsis, hipotensão, ecocardiografia, parâmetros dinâmicosResumo
O trabalho do Internista no Serviço de Urgência (SU) torna
pertinente a abordagem de certos temas controversos, entre os
quais o da utilização adequada de fluidoterapia na sépsis. Sendo
uma prática comum, em especial se a hipotensão está presente,
os seus efeitos adversos, objectivos e volume adequados são
pouco conhecidos. Os parâmetros que habitualmente nos guiam
quanto à quantidade de fluidos a administrar não são fidedignos
relativamente ao seu efeito no débito cardíaco, pelo que não
permitem uma adequada selecção dos doentes que benefi ciam
desta terapêutica. Os parâmetros dinâmicos de avaliação do efeito
da fluidoterapia são relativamente desconhecidos. A sua melhor
compreensão será mais um instrumento na decisão de administrar fluidos. Se os meios habituais de avaliação, em especial
clínicos, não permitem estabelecer com segurança que doentes
eleger para fluidoterapia ou início precoce de aminas, sugerimos
o treino em técnicas não invasivas, tal como a ecocardiografia,
em particular para o conjunto de internistas que habitualmente
trabalham em urgência e/ou emergência.
Baseados nas investigações mais recentes efectuadas na
área da terapêutica com fluidos, aborda-se neste artigo qual o
tipo e quantidade de fluidos a administrar, particularmente em
doentes com sépsis.
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