Monitoreo hemodinamico en sepsis.04.06.2011.

Dr. Agustín Omar Rosales Gutiérrez R4MI

[object Object],[object Object],[object Object],[object Object],1 .- Dellinger RP. Cardiovascular management of septic shock. Crit Care Med 2003; 31(3):946–55. 2.- Wheeler AP, Bernard GR, Thompson BT, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med 2006; 354(21):2213–24

[object Object],[object Object],[object Object],[object Object],3.-.-Brun-Buisson C, Doyon F, Carlet J, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. J Am Med Assoc 1995;274(12):968–74 . 4.- Trzeciak S, Dellinger RP, Chansky ME, et al. Serum lactate as a predictor of mortality in patients with infection. Intensive Care Med 2007;33(6):970–7. 5.- Rivers EP, Coba V, Visbal A, et al. Management of sepsis: early resuscitation. Clin Chest Med 2008;29(4):689–704, ix–x.

[object Object],[object Object],6.- Bland RD, Shoemaker WC, Abraham E, et al. Hemodynamic and oxygen transport patterns in surviving and nonsurviving postoperative patients. Crit Care Med 1985;13(2):85–90 . 7 - Kern JW, Shoemaker WC. Meta-analysis of hemodynamic optimization in highrisk patients. Crit Care Med 2002;30(8):1686–92.

Disminuciondel retorno venoso al corazon Decremento de la volumen de sistolico y de la FE Aumento de la FC y del tono vasomotor Perdida del la respuesta vascular, Aumento del GC Vasodilatacion sistemica global Citocinas inflamatorias = depresión miocardica Fuga capilar y disminución del tono vasomotor

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],8.- Partrick DA, Bensard DD, Janik JS, et al. Is hypotension a reliable indicator of loss from traumatic injury in children? Am J Surg 2002;184(6):555–9 [discussion: 559–60].

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],9.- Vieillard-Baron A, Augarde R, Prin S, et al. Influence of superior vena caval zone condition on cyclic changes in right ventricular outflow during respiratory support. Anesthesiology 2001;95(5):1083–8 10.- E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment severe sepsis and septic shock. N Engl J Med 2001;345(19):1368–77. 11.- Barbier C, Loubie`res Y, Schmit C, et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 2004;30(9):1740–6. 12.- Vieillard-Baron A, Augarde R, Prin S, et al. Influence of superior vena caval zone condition on cyclic changes in right ventricular outflow during respiratory support. Anesthesiology 2001;95(5):1083–8.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],13.- Polonen P, Ruokonen E, Hippela¨inen M, et al. A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg 2000;90(5):1052–9 .. 14.- Sakr Y, Vincent JL, Reinhart K, et al. Use of the pulmonary artery catheter is not associated with worse outcome in the ICU. Chest 2005;128(4):272–31. 15.- Reinhart K, Kuhn HJ, Hartog C, et al. Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med 2004; 30(8):1572–8.

[object Object],[object Object],[object Object],[object Object],[object Object],16.- Ospina-Tascon GA, Cordioli RL, Vincent JL. What type of monitoring has been shown to improve outcomes in acutely ill patients? Intensive Care Med 2008; 34(5):800–20 17.- Hall JB. Searching for evidence to support pulmonary artery catheter use in critically ill patients. J Am Med Assoc 2005;294(13):1693–4..

[object Object],[object Object],[object Object],18.- El libro de la UCI, Paul Marino, 3era edicion,, Capítulo 9, Cateter en la arteria pulmonar, 155-170, Wolters Kluver- Lippincott Williams y Wilkins, 2007 Bardelona España

[object Object],PARAMETRO ABREVIATURA VALORES NORMALES Presión venosa central PVC 1-6 mmHg Presion de enclavamiento capilar pulmonar PECP 6-12 mm Hg Indice cardiaco IC 2.4-4 l /min / m2 Indice de volumen sistolico IVS 40-70 ml/latido/m2 Indice de trabajo sistolico del VI ITSVI 40-60 gr . m /m2 En Ventriculo derecho: Indice de trabajo sistolico Fraccion de eyeccion Volumen telediastolico ITSVD FEVD VTDVD 4-8 gr . m /m2 40-50 % 80-150 ml /m2 Indice de resistencia vascular sistemica IRVS 4-8 gr . m /m2 Indice de resistencia vascular pulmonar IRVP 200-400 dinas-s1-cm5/m2

PARAMETRO SIMBOLO VALORES NORMALES Saturación venosa mixta de oxigeno SvO2 70-75 % Aporte de oxigeno AO2 520-570 ml /min/m2 captación de oxigeno VO2 110-160 ml/min/m2 Proporcion de extraccion de oxigeno PEO2 20-30 %

[object Object],[object Object],[object Object],[object Object],19- Michard F, Alaya S, Zarka V, et al. Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest 2003;124(5):1900–8. 20.- Michard F, Teboul JL, Richard C, et al. Arterial pressure monitoring in septic shock. Intensive Care Med 2003;29(4):659. 21.- De Backer D, Heenen S, Piagnerelli M, et al. Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med 2005;31(4): 517–23

[object Object],[object Object],[object Object],21.- De Backer D, Heenen S, Piagnerelli M, et al. Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med 2005;31(4): 517–23

[object Object],[object Object],[object Object],22.- Nishikawa T, Dohi S. Errors in the measurement of cardiac output by thermodilution. Can J Anaesth 1993;40(2):142–53.

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[object Object],[object Object],[object Object],[object Object],[object Object],23.- Jaeggi P, Hofer CK, Klaghofer R, et al. Measurement of cardiac output after cardiac surgery by a new transesophageal Doppler device. J Cardiothorac Vasc Anesth 2003;17(2):217–20. 24.- Dark PM, Singer M. The validity of trans-esophageal Doppler ultrasonography as a measure of cardiac output in critically ill adults. Intensive Care Med 2004;30(11):2060–6. 25.- Bilkovski RN, Rivers EP, Horst HM. Targeted resuscitation strategies after injury. Curr Opin Crit Care 2004;10(6):529–38.

[object Object],[object Object],[object Object],[object Object],[object Object],26.- Cholley BP, Vieillard-Baron A, Mebazaa A. Echocardiography in the ICU: time for widespread use! Intensive Care Med 2006;32(1):9–10 27.- Feissel M, Badie J, Merlani PG, et al. Pre-ejection period variations predict the fluid responsiveness of septic ventilated patients. Crit Care Med 2005;33(11): 2534–9.

Monitoreo hemodinamico en sepsis.04.06.2011.

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