Información del artículo
Resumen
La sepsis es resultado de una respuesta inadecuada y deletérea del huésped causado por una infección, la cual necesita de la identificación, diagnóstico y tratamiento oportunos. La sepsis ocasiona un gran porcentaje de la mortalidad y morbilidad en las unidades de cuidado intensivo. Desde hace más de una década las definiciones de la sepsis así como el enfoque diagnóstico y terapéutico han venido evolucionando debido al gran número de investigaciones desarrolladas sobre este tema. Este artículo proporciona una revisión completa de la sepsis, abarcando las nuevas definiciones, fisiopatología y recomendaciones sobre el diagnóstico y tratamiento.
Palabras clave:
Sepsis
Choque séptico
Infección
Epidemiología
Abstract
Sepsis is the result of inadequate and deleterious host response caused by infection, which requires the prompt identification, diagnosis and treatment. Sepsis causes a large percentage of the mortality and morbidity in intensive care units. The definition of sepsis and its diagnostic and therapeutic approach has been evolving for over a decade due to the large number of studies on this topic. This article provides a comprehensive review of sepsis, covering new definitions, pathophysiology, and recommendations on its diagnosis and treatment.
Keywords:
Sepsis
Septic shock
Infection
Epidemiology
Artículo
Opciones para acceder a los textos completos de la publicación Acta Colombiana de Cuidado Intensivo
Suscriptor
Comprar
Contactar
Teléfono para suscripciones e incidencias
De lunes a viernes de 9h a 18h (GMT+1) excepto los meses de julio y agosto que será de 9 a 15h
Llamadas desde España
932 415 960
Llamadas desde fuera de España
+34 932 415 960
E-mail
Bibliografía
[1]
A. Rhodes, L.E. Evans, W. Alhazzani, M.M. Levy, M. Antonelli, R. Ferrer, et al.
Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016.
Intensive Care Med [Internet], (2017 18), pp. 1-74
[citado 19 Feb 2017]. Disponible en: http://link.springer.com/10.1007/s00134-017-4683-6
[2]
F.B. Mayr, S. Yende, D.C. Angus.
Epidemiology of severe sepsis.
Virulence [Internet], 5 (2014), pp. 4-11
[citado 15 Mar 2016]. Disponible en: http://www.tandfonline.com/doi/abs/10.4161/viru.27372
[3]
G. Ortiz, C. Dueñas, F. Rodríguez, L. Barrera, G. de La Rosa, R. Dennis, et al.
Epidemiology of sepsis in Colombian intensive care units.
Biomédica Rev del Inst Nac Salud [Internet], 34 (2016), pp. 40-47
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/24967858
[4]
G. Ortiz, C. Dueñas, F. Rodríguez, L. Barrera, G. de La Rosa, R. Dennis, et al.
Epidemiología de la sepsis en unidades de cuidado intensivo en Colombia.
Biomédica [Internet], 34 (2013), pp. 40
[citado 17 Mar 2016]. Disponible en: http://www.revistabiomedica.org/index.php/biomedica/article/view/1439
[5]
C.A. López, V. Rodolfo, D. Verano.
Epidemiología de la sepsis en la Fundación Cardioinfantil-Instituto de Cardiologia-Bogota.
Universidad del Rosario, (2009),
[6]
R.P. Dellinger, M.M. Levy, A. Rhodes, D. Annane, H. Gerlach, S.M. Opal, et al.
Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock, 2012.
Intensive Care Med [Internet], 39 (2013), pp. 165-228
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/23361625
[7]
J.-L. Vincent, S.M. Opal, J.C. Marshall, K.J. Tracey.
Sepsis definitions: Time for change.
Lancet (London, England) [Internet], 381 (2013), pp. 774-775
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/23472921
[8]
M. Singer, C.S. Deutschman, C.W. Seymour, M. Shankar-Hari, D. Annane, M. Bauer, et al.
The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).
JAMA [Internet], 315 (2016), pp. 801-810
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/26903338
[9]
J.E. Carré, M. Singer.
Cellular energetic metabolism in sepsis: The need for a systems approach.
Biochim Biophys Acta [Internet], 1777 (2016), pp. 763-771
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/18482575
[10]
R. Huttunen, J. Aittoniemi.
New concepts in the pathogenesis, diagnosis and treatment of bacteremia and sepsis.
J Infect [Internet], 63 (2011 Dec), pp. 407-419
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/21840338
[11]
M. Malakooti, M. Kelleher, E. Wald.
Immune dysregulation in sepsis.
Clin Pediatr Emerg Med., 15 (2014), pp. 163-168
[12]
I. László, D. Trásy, Z. Molnár, J. Fazakas.
Sepsis: From pathophysiology to individualized patient care.
J Immunol Res [Internet], 2015 (2015), pp. 510436
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/26258150
[13]
M. Bosmann, P. Ward.
The inflammatory response in sepsis.
Trends Immunol., 34 (2013), pp. 129-136
[14]
U. Andersson, K.J. Tracey.
Reflex principles of immunological homeostasis.
Annu Rev Immunol [Internet], 30 (2012), pp. 313-335
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/22224768
[15]
R. Simon, M. Finfer.
Severe sepsis and septic shock.
N Engl J Med [Internet], 369 (2013),
2069-2069. [citado 15 Mar 2016]. Disponible en: http://www.nejm.org/doi/abs/10.1056/NEJMx130051
[16]
S.K. Hamlin, C.L. Parmley, S.K. Hanneman.
Microcirculatory alterations in shock states.
Crit Care Nurs Clin North Am [Internet], 26 (2014), pp. 399-412
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/25169692
[17]
C. Ince.
The microcirculation is the motor of sepsis.
Crit Care [Internet], 9 (2005), pp. S13
[citado 15 Mar 2016]. Disponible en: http://ccforum.com/content/9/S4/S13
[18]
D. De Backer, K. Donadello, F. Taccone, G. Ospina-Tascon, D. Salgado, J.-L. Vincent.
Microcirculatory alterations: Potential mechanisms and implications for therapy.
Ann Intensive Care [Internet], 1 (2011), pp. 27
[citado 15 Mar 2016]. Disponible en: http://www.annalsofintensivecare.com/content/1/1/27
[19]
S. Riedel, K.C. Carroll.
Laboratory detection of sepsis: Biomarkers and molecular approaches.
Clin Lab Med., 33 (2013), pp. 413-437
[20]
P. Póvoa.
C-reactive protein: A valuable marker of sepsis.
Intensive Care Med [Internet], 28 (2002), pp. 235-243
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/11904651
[21]
B. Uzzan, R. Cohen, P. Nicolas, M. Cucherat, G.-Y. Perret.
Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: A systematic review and meta-analysis.
Crit Care Med [Internet], 34 (2006 Jul), pp. 1996-2003
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/16715031
[22]
B.M.P. Tang, G.D. Eslick, J.C. Craig, A.S. McLean.
Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: Systematic review and meta-analysis.
Lancet Infect Dis [Internet], 7 (2007), pp. 210-217
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/17317602
[23]
C. Wacker, A. Prkno, F.M. Brunkhorst, P. Schlattmann.
Procalcitonin as a diagnostic marker for sepsis: A systematic review and meta-analysis.
Lancet Infect Dis [Internet], 13 (2013), pp. 426-435
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/23375419
[24]
M. Westwood, B. Ramaekers, P. Whiting, F. Tomini, M. Joore, N. Armstrong, et al.
Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: A systematic review and cost-effectiveness analysis.
Health Technol Assess [Internet], 19 (2015), pp. 1-236
v-xxv, [citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/26569153
[25]
E. Rivers, B. Nguyen, S. Havstad, J. Ressler, A. Muzzin, B. Knoblich, et al.
Early goal-directed therapy in the treatment of severe sepsis and septic shock.
N Engl J Med [Internet], 345 (2001), pp. 1368-1377
[citado 15 Mar 2016]. Disponible en: http://www.nejm.org/doi/abs/10.1056/NEJMoa010307
[26]
K. Bendjelid, J.A. Romand.
Fluid responsiveness in mechanically ventilated patients: A review of indices used in intensive care.
Intensive Care Med [Internet], 29 (2003), pp. 352-360
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/12536268
[27]
P.E. Marik, M. Baram, B. Vahid.
Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares.
Chest [Internet], 134 (2008), pp. 172-178
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/18628220
[28]
J. Bakker, M.W. Nijsten, T.C. Jansen.
Clinical use of lactate monitoring in critically ill patients.
Ann Intensive Care [Internet], 3 (2013), pp. 12
[citado 15 Mar 2016]. Disponible en: http://www.annalsofintensivecare.com/content/3/1/12
[29]
R.G. Gupta, S.M. Hartigan, M.G. Kashiouris, C.N. Sessler, G.M.L. Bearman.
Early goal-directed resuscitation of patients with septic shock: Current evidence and future directions.
Crit Care [Internet], 19 (2015), pp. 286
[citado 15 Mar 2016]. Disponible en: http://ccforum.com/content/19/1/286
[30]
Y. Sakr, M.-J. Dubois, D. de Backer, J. Creteur, J.-L. Vincent.
Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock.
Crit Care Med [Internet], 32 (2004), pp. 1825-1831
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/15343008
[31]
M. Cecconi, C. Hofer, J.-L. Teboul, V. Pettila, E. Wilkman, Z. Molnar, et al.
Fluid challenges in intensive care: the FENICE study: A global inception cohort study.
Intensive Care Med [Internet], 41 (2015), pp. 1529-1537
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/26162676
[32]
P. Marik, R. Bellomo.
A rational approach to fluid therapy in sepsis.
Br J Anaesth [Internet], 116 (2016), pp. 339-349
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/26507493
[33]
A.E. Fiore, A. Fry, D. Shay, L. Gubareva, J.S. Bresee, T.M. Uyeki, et al.
Antiviral agents for the treatment and chemoprophylaxis of influenza–recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR Recomm Rep [Internet], 60 (2011), pp. 1-24
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/21248682
[34]
M. Bernhard, C. Lichtenstern, C. Eckmann, M.A. Weigand.
The early antibiotic therapy in septic patients-milestone or sticking point?.
Crit Care [Internet], 18 (2014), pp. 671
[citado 15 Mar 2016]. Disponible en: http://ccforum.com/content/18/6/671
[35]
L.A. Mandell, R.G. Wunderink, A. Anzueto, J.G. Bartlett, G.D. Campbell, N.C. Dean, et al.
Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.
Clin Infect Dis [Internet], 44 Suppl 2 (2007), pp. S27-S72
[citado 15 Mar 2016 Mar 15]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/17278083
[36]
J.M. Pereira, J.A. Paiva, J. Rello.
Severe sepsis in community-acquired pneumonia–early recognition and treatment.
Eur J Intern Med [Internet], 23 (2012), pp. 412-419
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/22726369
[37]
Asociación Colombiana de Neumología y Cirugía de Tórax (ACNCT), Asociación Colombiana de Medicina Crítica y Cuidado Intensivo (AMCI), Asociación Colombiana de Medicina Interna (ACMI) AC de I (ACIN). Recomendaciones para el diagnóstico, tratamiento y prevención de la neumonía adquirida en la comunidad en adultos inmunocompetentes. Infectio. 2013;17:1-38.
[38]
D. Koulenti, J. Rello.
Gram-negative bacterial pneumonia: Aetiology and management.
Curr Opin Pulm Med [Internet], 12 (2006), pp. 198-204
[citado 25 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/16582675
[39]
T.M. File, D.E. Low.
Unmet needs for the treatment of moderate-to-severe or hospitalized community-acquired pneumonia.
Clin Pulm Med [Internet], 16 (2009), pp. 243-251
[citado 25 Mar 2016]. Disponible en: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00045413-200909000-00002
[40]
M. Bodi, C. Ardanuy, M. Olona, D. Castander, E. Diaz, J. Rello.
Therapy of ventilator-associated pneumonia: The Tarragona Strategy.
Clin Microbiol Infect [Internet], 7 (2001), pp. 32-33
[citado 15 Mar 2016]. Disponible en: http://linkinghub.elsevier.com/retrieve/pii/S1198743X14637319
[41]
F.M.E. Wagenlehner, A. Pilatz, W. Weidner.
Urosepsis—from the view of the urologist.
Int J Antimicrob Agents., 38 (2011), pp. 51-57
[42]
E. Shaw, N. Benito, J. Rodríguez-Baño, B. Padilla, V. Pintado, E. Calbo, et al.
Risk factors for severe sepsis in community-onset bacteraemic urinary tract infection: Impact of antimicrobial resistance in a large hospitalised cohort.
J Infect [Internet], 70 (2015), pp. 247-254
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/25305497
[43]
J. Medina-Polo, F. Guerrero-Ramos, S. Pérez-Cadavid, A. Arrébola-Pajares, R. Sopeña-Sutil, R. Benítez-Sala, et al.
Community-associated urinary infections requiring hospitalization: Risk factors, microbiological characteristics and patterns of antibiotic resistance.
Actas Urol Esp [Internet], 39 (2015), pp. 104-111
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/25301702
[44]
L. González, J.A. Cortés, J.A. Cortés.
Revisión sistemática de la resistencia antimicrobiana en enterobacterias en aislamientos intrahospitalarios en Colombia.
Biomédica [Internet], 34 (2013), pp. 180-197
[citado 21 Oct 2016]. Disponible en: http://www.revistabiomedica.org/index.php/biomedica/article/view/1550
[45]
F.M.E. Wagenlehner, A. Pilatz, K.G. Naber, W. Weidner.
Therapeutic challenges of urosepsis.
Eur J Clin Invest [Internet], 38 Suppl 2 (2008), pp. 45-49
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/18826481
[46]
I. Brook, E.H. Frazier.
Aerobic and anaerobic microbiology in intra-abdominal infections associated with diverticulitis.
J Med Microbiol [Internet]., 49 (2000), pp. 827-830
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/10966232
[47]
J.A. Weigelt.
Empiric treatment options in the management of complicated intra-abdominal infections.
Cleve Clin J Med [Internet], 74 Suppl 4 (2007), pp. S29-S37
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/17847176
[48]
J.S. Paul, T.J. Ridolfi.
A case study in intra-abdominal sepsis.
Surg Clin North Am [Internet], 92 (2012), pp. 1661-1677
[citado 15 Mar 2016]. Disponible en: http://linkinghub.elsevier.com/retrieve/pii/S0039610912001648
[49]
K. Raghunathan, M. Singh, D.N. Lobo.
Fluid management in abdominal surgery.
Anesthesiol Clin [Internet], 33 (2015), pp. 51-64
[citado 15 Mar 2016]. Disponible en: http://linkinghub.elsevier.com/retrieve/pii/S193222751400130X
[50]
J.S. Solomkin, J.E. Mazuski, J.S. Bradley.
Diagnosis and management of complicated intra-abdominal infections in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America.
Surg Infect., 11 (2010), pp. 79-109
[51]
C. Eckmann, M. Dryden, P. Montravers, R. Kozlov, G. Sganga.
Antimicrobial treatment of “complicated” intra-abdominal infections and the new IDSA guidelines? a commentary and an alternative European approach according to clinical definitions.
Eur J Med Res [Internet], 16 (2011), pp. 115-126
[citado 29 Oct 2016 29]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/21486724
[52]
D.L. Stevens, A.L. Bisno, H.F. Chambers, E.P. Dellinger, E.J.C. Goldstein, S.L. Gorbach, et al.
Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America.
Clin Infect Dis., 59 (2014),
[53]
A. Iglesias, R. Pineda.
Piomiositis tropical.
Acta Med Colomb., 5 (1980), pp. 33-43
[54]
D.P. Phillips, A.M. Kaynar, J.A. Kellum, H. Gomez.
Crystalloids vs. colloids: KO at the twelfth round?.
Crit Care [Internet], 17 (2013), pp. 319
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/23731998
[55]
B. Guidet, O. Martinet, T. Boulain, F. Philippart, J.F. Poussel, J. Maizel, et al.
Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch 130/0.4 vs. 0.9% NaCl fluid replacement in patients with severe sepsis: The CRYSTMAS study.
Crit Care [Internet], 16 (2012), pp. R94
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/22624531
[56]
J.A. Myburgh, S. Finfer, R. Bellomo, L. Billot, A. Cass, D. Gattas, et al.
Hydroxyethyl starch or saline for fluid resuscitation in intensive care.
N Engl J Med [Internet], 367 (2012), pp. 1901-1911
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/23075127
[57]
D. Annane.
Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock.
JAMA [Internet], 310 (2013), pp. 1809
[citado 15 Mar 2016]. Disponible en: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2013.280502
[58]
J.-L. Vincent, L. Gottin.
Type of fluid in severe sepsis and septic shock.
Minerva Anestesiol [Internet], 77 (2011), pp. 1190-1196
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/21750487
[59]
S. Finfer, R. Bellomo, N. Boyce, J. French, J. Myburgh, R. Norton, SAFE Study Investigators.
A comparison of albumin and saline for fluid resuscitation in the intensive care unit.
N Engl J Med., 350 (2004), pp. 2247-2256
[60]
T.J. Ellender, J.C. Skinner.
The use of vasopressors and inotropes in the emergency medical treatment of shock.
Emerg Med Clin North Am [Internet]., 26 (2008), pp. 759-786
[citado 15 Mar 2016]. Disponible en: http://linkinghub.elsevier.com/retrieve/pii/S0733862708000461
[61]
V. Beck, D. Chateau, G.L. Bryson, A. Pisipati, S. Zanotti, J.E. Parrillo, et al.
Timing of vasopressor initiation and mortality in septic shock: A cohort study.
Crit Care [Internet], 18 (2014), pp. R97
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/24887489
[62]
S.M. Hollenberg.
Inotrope and vasopressor therapy of septic shock.
Crit Care Nurs Clin North Am [Internet], 23 (2011), pp. 127-148
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/21316572
[63]
Y. Sutherasan, M. Vargas, P. Pelosi.
Protective mechanical ventilation in the non-injured lung: Review and meta-analysis.
Crit Care [Internet], 18 (2014), pp. 211
[citado 15 Mar 2016]. Disponible en: http://ccforum.com/content/18/2/211
[64]
J.C. Garcia Casallas.
Guía de farmacoterapéutica de inmunoglobulina IgG enriquecida con IgM e IgA.
Acta Colomb Cuid Intensivo, 15 (2015), pp. 103-108
[65]
G.P. Patel, R.A. Balk.
Systemic steroids in severe sepsis and septic shock.
Am J Respir Crit Care Med [Internet], 185 (2012), pp. 133-139
[citado 30 Oct 2016]. Disponible en: http://www.atsjournals.org/doi/abs/10.1164/rccm.201011-1897CI
[66]
J. Briegel, H. Forst, M. Haller, G. Schelling, E. Kilger, G. Kuprat, et al.
Stress doses of hydrocortisone reverse hyperdynamic septic shock: A prospective, randomized, double-blind, single-center study.
Crit Care Med [Internet], 27 (1999), pp. 723-732
[citado 30 Oct 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/10321661
[67]
O. Yildiz, M. Doganay, B. Aygen, M. Güven, F. Keleştimur, A. Tutuû.
Physiological-dose steroid therapy in sepsis.
Crit Care [Internet], 6 (2002), pp. 251-259
[citado 30 Oct 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/12133187
[68]
M. Oppert, R. Schindler, C. Husung, K. Offermann, K.-J. Gräf, O. Boenisch, et al.
Low-dose hydrocortisone improves shock reversal and reduces cytokine levels in early hyperdynamic septic shock.
Crit Care Med [Internet], 33 (2005), pp. 2457-2464
[citado 30 Oct 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/16276166
[69]
C.L. Sprung, D. Annane, D. Keh, R. Moreno, M. Singer, K. Freivogel, et al.
Hydrocortisone therapy for patients with septic shock.
N Engl J Med [Internet], 358 (2008), pp. 111-124
[citado 30 Oct 2016]. Disponible en: http://www.nejm.org/doi/abs/10.1056/NEJMoa071366
[70]
P.E. Bollaert, C. Charpentier, B. Levy, M. Debouverie, G. Audibert, A. Larcan.
Reversal of late septic shock with supraphysiologic doses of hydrocortisone.
Crit Care Med [Internet], 26 (1998), pp. 645-650
[citado 30 Oct 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/9559600
[71]
L.C. Sanches, L.C. Pontes Azevedo, R. Salomão, M.A. Noguti, M. Brunialti, D.M. Lourenço, et al.
Association between early glycemic control and improvements in markers of coagulation and fibrinolysis in patients with septic shock-induced stress hyperglycemia.
J Crit Care [Internet], 29 (2014), pp. e8841-e8846
[citado 15 Mar 2016]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/24891151
[72]
S. Finfer, D.R. Chittock, S.Y.S. Su, D. Blair, D. Foster, NICE-SUGAR Study Investigators, et al.
Intensive versus conventional glucose control in critically ill patients.
N Engl J Med., 360 (2009), pp. 1283-1297
[73]
B.E. Taylor, S.A. McClave, R.G. Martindale, M.M. Warren, D.R. Johnson, C. Braunschweig, et al.
Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient.
Crit Care Med [Internet], 44 (2016), pp. 390-438
[citado 15 Mar 2016]. Disponible en: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00003246-201602000-00020
[74]
M.P. Casaer, D. Mesotten, G. Hermans, P.J. Wouters, M. Schetz, G. Meyfroidt, et al.
Early versus late parenteral nutrition in critically ill adults.
N Engl J Med [Internet], 365 (2011), pp. 506-517
[citado 29 Oct 2016]. Disponible en: http://www.nejm.org/doi/abs/10.1056/NEJMoa1102662
