Rocha Leonardo Lima, Pessoa Camila Menezes Souza, Corrêa Thiago Domingos, Pereira Adriano José, de Assunção Murillo Santucci Cesar, Silva Eliézer
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Braz J Anesthesiol. 2015 Sep-Oct;65(5):395-402. doi: 10.1016/j.bjane.2014.11.006. Epub 2015 Jul 9.
Severe 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.
严重脓毒症和脓毒性休克是医疗保健面临的重大挑战。与脓毒性休克相关的死亡率的改善很大程度上与早期识别、及时的液体复苏和适当的抗生素使用有关。脓毒性休克复苏的主要目标包括血管内补液、维持足够的灌注压力以及向组织输送氧气。为实现这些目标，可能需要进行液体反应性评估以及补充干预措施，即使用血管升压药、正性肌力药和输血。本文是一篇文献综述，内容涉及急诊科或重症监护病房中脓毒性休克患者初始血流动力学支持的现有证据，以及为实现这些目标可采用的主要干预措施，重点是液体和血管升压药治疗、输血和正性肌力药的使用。
