Información del artículo
Resumen
El choque séptico representa una urgencia médica con mortalidad persistente del 20-40%. Tradicionalmente, la reanimación se ha basado en metas fijas aplicadas homogéneamente, sin considerar la heterogeneidad fenotípica individual, lo que probablemente se asocia a la no mejora de desenlaces en estos pacientes. Esta revisión examina la evidencia que sustenta estrategias personalizadas basadas en: tiempo de llenado capilar como marcador superior al lactato, fenotipificación hemodinámica, modelo de Windkessel como guía para el manejo, predictores dinámicos de respuesta a volumen y desreanimación temprana. Con la revisión de esta evidencia se propone un enfoque terapéutico basado en la personalización del manejo según las particularidades clínicas y fisiológicas de los pacientes con choque séptico para así poder mejorar su pronóstico.
Palabras clave:
Choque séptico
Reanimación con líquidos
Perfusión tisular
Llenado capilar
Monitorización hemodinámica
Sobrecarga de líquidos
Desreanimación
Abstract
Septic shock represents a medical emergency with a persistent mortality rate of 20-40%. Traditionally, resuscitation has been based on fixed goals applied uniformly, without considering individual phenotypic heterogeneity, which is likely associated with the lack of improvement in outcomes for these patients. This review examines the evidence supporting personalized strategies based on: capillary refill time as a superior marker to lactate, hemodynamic phenotyping, the Windkessel model as a guide for management, dynamic predictors of volume responsiveness, and early de-resuscitation. Based on this evidence review, a therapeutic approach is proposed that personalizes management according to the clinical and physiological characteristics of patients with septic shock in order to improve their prognosis.
Keywords:
Septic shock
Fluid resuscitation
Tissue perfusion
Capillary refill time
Hemodynamic monitoring
Fluid overload
Deresuscitation
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