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Sepsis y Trauma
- 1. SEPSIS Y TRAUMA GUILLERMO ORTIZ RUIZ M.D. Unidad de Cuidado Intensivo HOSPITAL SANTA CLARA
- 2. SEPSIS Y TRAUMA • ASOCIACIÓN ENTRE SEPSIS Y TRAUMA • DIAGNÓSTICO DE SEPSIS EN EL PACIENTE CON TRAUMA. • TERAPIAS ACTUALES EN SEPSIS. • ABORDAJE FUTURO DEL PACIENTE SÉPTICO
- 5. • 199 UNIDADES,24 PAISES • DURACION:DOS SEMANAS • 3147 PACIENTES-1177 CON SEPSIS
- 6. • MORTALIDAD EN UCI 27% CON SEPSIS VS 14% SIN SEPSIS • MORTALIDAD HOSPITALARIA 36% CON SEPSIS VS 17% SIN SEPSIS
- 9. Bacterial Translocation across Microvilli and How It Spreads into the Bloodstream
- 13. • POLIMORFISMO DE IL-6
- 20. Hypermetabolic Response to Stress—Cause Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.
- 33. LIST OF THERAPIES CURRENTLY AVALAIBLE FOR EVENTUALLY TREATING SEVERE SEPSIS
- 34. 2/4 SIRS, PAS<90 Terapia Terapia “temprana” 263 Pacientes dirigida por objetivos estándar PVC >8-12 Golden hour PAM >65 mm Hg GU >0.5 mlK/h SvO2 > 70% PVC >8-12 PAM >65 mm Hg GU >0.5 ML/K/H 6h SaO2 >93% Hcto >30% Indice cardíaco VO2 Reducción de % Mortalidad a 28 dias 15.9% NNT : 6 Riesgo absoluto 49.2 33.3
- 38. Colloids versus crystalloids for fluid resuscitation in critically ill patients Alderson P, Schierhout G, Roberts I, Bunn F The Cochrane Library, Issue 1, 2003. Oxford
- 43. Feb 2, 2000 Tratamiento intensivo con insulina, glucosa entre 80mg/dl y 110 mg/dl Tratamiento convencional con insulina, glucosa entre 180mg/dl y 200 mg/dl solo si glucosa >215mg/dl 1548 ptes 8.0% RRA 3.4% = NNT 29 % Mortalidad 4.6% 85/783 55/765 Reducción de la Mortalidad general 34% •DOM •Foco séptico probado
- 64. Jul 1998 96h 28d 90d 2.5a 1690 ptes 30.8% RRA 6.1% = NNT 16 % Mortalidad 24.7% 259/840 210/850
- 66. N (APC) Placebo GRAL 1690 24.7 30.8 3-19 433 15.1 12.1 20-25 440 22.5 25.7 26-29 366 23.5 35.8 30-53 451 38.1 49.0 0.5 0.6 0.7 0.8 0.9 1 1.25 1.67 2 Riesgo relativo de muerte ( CI 95% )
- 68. Is Drotrecogin Alfa (Activated) Safe and Effective For Surgical Patients?
- 69. Determination of the Surgical Cohort Non-surgical PROWESS 1690 1158 1216 (72%) Selection Cohort 532 (31.5%) 58 Surgical Cohort 474 (28.0%) Xigris 228 (48.1) Placebo 246 (51.9%)
- 70. Primary Source of Infection by Surgical Status Surgical Non-surgical N=468 N=1,117 n (%) n (%) Lung 95 (20.3) 790 (67.5) p<0.001 Intra-abdominal 295 (63.0) 68 (5.8) p<0.001 Urinary 23 (4.9) 179 (15.3) p<0.001 Note: Source of infection determined by the PROWESS Surgical Evaluation Committee .
- 71. DrotAA was Associated with Increased Survival in Both Surgical and Non-surgical Patients Surgical Patients Non-surgical Patients 100 100 DrotAA, n=1230 rhAPC, n = 1995 Placebo, n = 274 Placebo, n = 566 95 95 Survival Rate (%) 90 90 85 85 80 80 75 75 70 70 0 7 14 21 28 0 7 14 21 28 Days Days 28-day mortality 28-day mortality Surgical patients Non-surgical patients Placebo = 30.9% vs. DrotAA = 24.4% Placebo = 30.7% vs. DrotAA = 26.3%
- 72. Prevention of infection in multiple trauma patients by high- dose intravenous immunoglobulins [Feature Articles] Douzinas, Emmanuel E. MD; Pitaridis, Marinos T. MD; Louris, George MD; Andrianakis, Ilias MD; Katsouyanni, Klea DrMedSc; Karmpaliotis, Dimitrios MD; Economidou, Joanna MD; Sfyras, Dimitrios MD; Roussos, Charis MD, PhD Volume 28(1) January 2000 pp 8-15
- 73. • MORTALIDAD • DÍAS EN CUIDADOS INTENSIVOS • DÍAS EN VENTILACIÓN MECÁNICA
- 91. CONCLUSIONES • ASOCIACIÓN TRAUMA Y SEPSIS- ANÁLISIS TEMPORAL DEL SIRS. • DIFICULTAD DIANÓSTICA DE LA INFECCIÓN EN TRAUMA. • VENTAJAS DE LA IMPLEMENTACIÓN DE TERAPIAS ACTUALES. • FUTURO-ESTRATIFICACION DE LA INFECCIÓN.