Información del artículo
Resumen
En el año 2001, Rivers y sus colaboradores publican los resultados de un ensayo clínico aleatorizado, donde un protocolo de terapia temprana guiada por metas clínicas y hemodinámicas en pacientes con choque séptico demostró disminuir la mortalidad respecto al cuidado usual. Este protocolo incluía la inserción de catéter venoso central para medición continua de presión venosa y saturación venosa central de oxígeno, así como la administración de glóbulos rojos para aquellos pacientes con saturación venosa central<70%. Estos hallazgos no han podido ser reproducidos por otros estudios, por lo cual, la estrategia de Rivers ha sido objeto de debate durante los últimos años. En este artículo se revisa la evidencia actual de la terapia temprana dirigida por metas y se propone un algoritmo de manejo inicial para choque séptico acorde con los estudios publicados.
Palabras clave:
Terapia temprana dirigida por metas
Sepsis grave
Choque séptico
Abstract
In 2001, Rivers and colleagues published the results of a randomised clinical trial, where a protocol for early therapy guided by clinical and haemodynamic goals in patients with septic shock demonstrated a reduction in mortality compared to usual care. This protocol includes the insertion of a central venous catheter for continuous measurement of central venous pressure and venous oxygen saturation, and the administration of red blood cells for patients with central venous oxygen saturation below 70%. These findings could not be reproduced by other studies, thus, Rivers strategy has been debated over the last few years. In this article, current evidence of early goal-directed therapy is reviewed, and an algorithm for initial management of septic shock, consistent with published studies is proposed.
Keywords:
Early goal-directed therapy
Severe sepsis
Septic shock
Artículo
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Bibliografía
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