Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.11.006
Brazilian Journal of Anesthesiology
Review Article

Current concepts on hemodynamic support and therapy in septic shock

Conceitos atuais sobre suporte hemodinâmico e terapia em choque séptico

Leonardo Lima Rocha; Camila Menezes Souza Pessoa; Thiago Domingos Corrêa; Adriano José Pereira; Murillo Santucci Cesar de Assunção; Eliézer Silva

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Abstract

ABSTRACTSevere sepsis and septic shock represent a major healthcare challenge. Much of the improvement in mortality associated with septic shock is related to early recognition combined with timely fluid resuscitation and adequate antibiotics administration. The main goals of septic shock resuscitation include intravascular replenishment, maintenance of adequate perfusion pressure and oxygen delivery to tissues. To achieve those goals, fluid responsiveness evaluation and complementary interventions - i.e. vasopressors, inotropes and blood transfusion - may be necessary. This article is a literature review of the available evidence on the initial hemodynamic support of the septic shock patients presenting to the emergency room or to the intensive care unit and the main interventions available to reach those targets, focusing on fluid and vasopressor therapy, blood transfusion and inotrope administration.

Keywords

Septic shock, Hemodynamics, Resuscitation, Fluid therapy, Vasoconstrictor agents

Resumo

RESUMOA sepse grave e o choque séptico são um grande desafio para a assistência médica. Grande parte da melhoria na taxa de mortalidade associada ao choque séptico está relacionada ao reconhecimento precoce em combinação com a reposição volêmica oportuna e a administração adequada de antibióticos. Os principais objetivos da reanimação do choque séptico incluem reposição intravascular, manutenção adequada da pressão de perfusão e fornecimento de oxigênio para os tecidos. Para atingir esses objetivos, a avaliação da responsividade do volume e das intervenções complementares (vasopressores, inotrópicos e transfusão de sangue) pode ser necessária. Este artigo é uma revisão da literatura para identificar as evidências disponíveis do suporte hemodinâmico inicial aos pacientes com choque séptico admitidos em sala de emergência ou unidade de terapia intensiva e as principais intervenções disponíveis para atingir essas metas, com foco em terapia com reposição de líquidos e vasopressores, transfusão de sangue e administração de inotrópicos.

Palavras-chave

Choque séptico, Hemodinâmica, Reposição volêmica, Fluidoterapia, Agentes vasoconstritores

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