Novidades na Sépsis com Implicações na Prática Clínica

Autores

  • António Carneiro Departamento de Medicina, UCI e Urgência, Hospital Luz Arrábida – Grupo Luz Saúde, Vila Nova de Gaia, Portugal
  • J. Andrade-Gomes Unidade de Cuidados Intensivos, Hospital da Luz Lisboa – Grupo Luz Saúde, Lisboa, Portugal
  • P. Póvoa 1. Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal 2. NOVA Medical School/Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal

DOI:

https://doi.org/10.24950/rspmi.786

Palavras-chave:

Sépsis, Síndrome de Resposta Inflamatória Sistémica, Unidades de Cuidados Intensivos

Resumo

A sépsis é a resposta do organismo à infeção. Na sépsis grave há três
intervenções que comprovadamente salvam vidas: 1. Reconhecimento
precoce com estratificação de gravidade; 2. Prevenção e suporte de
órgãos em disfunção otimizando o fornecimento de O2 (DO2); 3.
Controlo do foco com antibioterapia adequada e cirurgia / drenagem
(quando indicado). Depois da publicação das recomendações SSC
2012 surgiram na literatura novidades que impõem atualização da prática
clínica. As manifestações inicias dependem do estado imunológico
e da presença de comorbilidades. O número de manifestações de
SIRS correlaciona-se com o prognóstico e exigem a pesquisa de critérios
de gravidade que quando presentes impõem intervenção urgente.
As manifestações de disóxia (hiperlactacidemia) de hipotensão que
não responde ao preenchimento adequado e/ou se associa a disfunção
de órgãos de novo, são as mais graves. Na prescrição de fluidos
na sépsis proscreveram-se amidos e gelatinas, reconheceu-se que
a albumina não tem efeitos nefastos nem lugar na reposição volémica,
que os cristaloides equilibrados são preferíveis e que a perfusão
excessiva de NaCl 0,9% implica risco de acidemia hiperclorémica A
ecografia, ao lado do doente, tem papel relevante no diagnóstico
diferencial e estratificação de gravidade, na avaliação da resposta ao
tratamento e na identificação da causa da sépsis. A estratificação de
gravidade e a monitorização do tratamento devem seguir a estratégia
“2O+2C”, resumida em 4 perguntas: Como está a oxigenação?
Como está a circulação? Como estão os órgãos nobres? Como está a
célula? A sépsis grave é uma urgência que exige tratamento imediato.

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Publicado

31-03-2016

Como Citar

1.
Carneiro A, Andrade-Gomes J, Póvoa P. Novidades na Sépsis com Implicações na Prática Clínica. RPMI [Internet]. 31 de Março de 2016 [citado 24 de Abril de 2024];23(1):44-52. Disponível em: https://revista.spmi.pt/index.php/rpmi/article/view/786

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