Sepsis y embarazo

SEPSIS EN EL EMBARAZO Samuel G é lvez T é llez Ginecologia y Obstetricia Universidad de Antioquia Medellin-Colombia

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Crit Care Med 2001; 29: 1303-1310

Sepsis en el embarazo ,[object Object],[object Object],[object Object],[object Object],Obstet Gynecol 1981; 58: 621-625

[object Object],[object Object],Acta Obstet Gynecol Scand 2003; 82: 730-735

[object Object],[object Object],[object Object],[object Object],Maternal Mortality in 2000, WHO 2003

Mortalidad materna en Antioquia Distribución según causa básica de muerte 2004 CLAP/OPS-OMS/UdeA

[object Object],[object Object],[object Object],[object Object],[object Object],Crit Care Clin 2004; 20: 651-660

ACCP/SCCM 1992 ,[object Object],[object Object],[object Object]

ACCP/SCCM 1992 ,[object Object],[object Object]

ACCP/SCCM 1992 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ACCP/SCCM 1992 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Microbiologia y factores de riesgo materno ,[object Object],[object Object],[object Object],[object Object],[object Object],Clin Obstet Gynecol 2002; 45: 393-404

PATOFISIOLOGIA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Infecciones asociadas a SS en el embarazo ,[object Object],[object Object],[object Object],[object Object]

Complicaciones: ,[object Object],[object Object],[object Object],[object Object],Sepsis 8-10%

LIPIDO A Componente activo de la endotoxina CASCADA INFLAMATORIA HISTAMINA BRADICININAS S.SEPTICO CID INSUFICIENCIA RESPIRATORIA SDRA 1-8%

Corioamnionitis y Aborto Séptico :

Infecciones asociadas a SS en el embarazo ,[object Object],[object Object],[object Object]

[object Object],[object Object]

[object Object],[object Object],[object Object],N Engl J Med, 345, No 19. Nov 2001

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],N Engl J Med, 345, No 19. Nov 2001

A. Reanimación Inicial ,[object Object],[object Object],[object Object]

METAS ScvO2 DIURESIS PAM PVC 8-12 mmHG >= 65 mmHg. > 0.5 cc/ K / h. >= 70%.

Reanimación Inicial ,[object Object],[object Object],[object Object],[object Object]

B. DIAGNOSTICO ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J Clin Microbial 1998; 36: 105-109

C. TERAPIA ANTIBIOTICA ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object]

D. CONTROL DE LA FUENTE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Septic Shokc during Pregnancy. Am J Obstet Gynecol 1998; 159: 410-416

E. LEV ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

F. VASOPRESORES ,[object Object],[object Object]

F. VASOPRESORES ,[object Object],[object Object],[object Object],[object Object],[object Object]

F. VASOPRESORES ,[object Object],[object Object],[object Object]

F. VASOPRESORES ,[object Object]

G. TERAPIA INOTROPICA ,[object Object],[object Object],[object Object]

H. ESTEROIDES ,[object Object]

Estimulación con ACTH (250 mcg) INCREMENTO DEL CORTISOL <= 9 mcg INCREMENTO DEL CORTISOL > 9 mcg HIDROCORTISONA FLUDOCORTISONA NO TRATAR

[object Object],Crit Care Med 1999; 27: 723-732

[object Object],[object Object],[object Object],[object Object],[object Object],Jama 2002. Vol 288 No. 7, 862-872

[object Object],[object Object],[object Object],[object Object],Jama 2002. Vol 288 No. 7, 862-872

[object Object],[object Object],Placebo: 115 Corticoides: 114 Placebo: 34 Corticoides: 36 Jama 2002. Vol 288 No. 7, 862-872

[object Object],[object Object],[object Object],Jama 2002. Vol 288 No. 7, 862-872

I. PROTEINA C ACTIVA HUMANA RECOMBINANTE (rhAPC) ,[object Object],[object Object],[object Object],N Engl J Med; 2001: 344: 409417

J. PRODUCTOS SANGUINEOS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

K. VENTILACION MECANICA EN SDRS - IS ,[object Object],[object Object],[object Object]

Mortalidad: 31% (432) vs 39.8 (439) %p=0.007 Días sin ventilador: 12 +- 11 vs 10+-11 p=0.007

L. SEDACION, ANALGESIA ,[object Object],[object Object]

M. CONTROL DE LA GLUCOSA ,[object Object],[object Object],[object Object],[object Object]

T. Convensional: insulina si glucosa >215 (180-200) T. Intensivo: Glucosa > 110 (80-110) 50 UI Actapid HM + 50 cc de ss

N. REEMPLAZO RENAL ,[object Object],[object Object],[object Object],[object Object]

O. BICARBONATO ,[object Object],[object Object]

P. PROFILAXIS DE TVP ,[object Object],[object Object]

Q. PROFILAXIS DE ULCERAS DE STRESS ,[object Object]

Sepsis y embarazo

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Sepsis y embarazo