MANEJO ANESTESICO DEL PACIENTE SÉPTICO.pptx

SEPSIS AND SEPTIC SHOCK ANESTHESIA MANAGEMENT

1. ANESTESIA EN PACIENTE SÉPTICO R2A JOSÉ GERARDO MALANCO ARIAS

2. contenido FACTORES DE RIESGO DEFINIENDO SEPSIS MANEJO PREANESTÉSICO Y VALORACIÓN MANEJO PREANESTÉSICO ANTIBIOTICOTERAPIA MANEJO INTRAOPERATORIO MEDIDAS DE PROTECCIÓN EN VMI CONSIDERACIONES POSOPERATORIO

3. FACTORES DE RIESGO > 65 años, recién personas embarazadas, nacidos y lactantes Enfermedades cronicodegenerativas Depresión inmunológica Hospitalización Lesiones graves, como grandes quemaduras o heridas Pacientes con accesos vasculares o ventilación mecánica Evans, L., Rhodes, A., Alhazzani, W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47, 1181–1247 (2021). https://doi.org/10.1007/s00134-021-06506-y Carsetti,A .; et. al.; "Anesthetic Management of patients with sepsis and septic shock" Frontiers in Medicine, Intensive Care Medicine and Anesthesiology, Jan. 2023

4. DEFINIENDO SEPSIS 2002 -- Declaración de Barcelona -- Sociedad Europea de Medicina Crítica Choque séptico: Sepsis + Hipotensión persistente que requiere de vasopresores para mantener TAM + Lactato >2mmol/L a pesar de la reanimación Evans, L., Rhodes, A., Alhazzani, W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47, 1181–1247 (2021). https://doi.org/10.1007/s00134-021-06506-y Emergencias médicas que deben de ser manejadas con objetivos de reanimación individualizada

5. Evans, L., Rhodes, A., Alhazzani, W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47, 1181–1247 (2021). https://doi.org/10.1007/s00134-021-06506-y

6. Dellinger, R.P., et. al.; "CCM 50TH anniversary article, Surviving Sepsis Campaign", Society of Critical Care Medicine and Wolfer Kluwer Health, 2023

7. MANEJO PREANESTÉSICO Y VALORACIÓN Identificar disfunción orgánica – q-SOFA Optimización hemodinámica previo a la inducción Uso de soluciones cristaloides balanceadas Carsetti,A.; et. al.; "Anesthetic Management of patients with sepsis and septic shock" Frontiers in Medicine, Intensive Care Medicine and Anesthesiology, Jan. 2023

8. Royal College of Physicians. National Early Warning Score (NEWS2): Standardising the assessment of acute illness News 2

9. News 2 Royal College of Physicians. National Early Warning Score (NEWS2): Standardising the assessment of acute illness

10. Apache ii Okazaki, H.; "New scoring system (APACHE-HF) for predicting adverse outcomes in patients with acute heart failure: Evaluation of the APACHE II and Modified APACHE II scoring systems"; Japanese College of Cardiology; 2019

11. Okazaki, H.; "New scoring system (APACHE-HF) for predicting adverse outcomes in patients with acute heart failure: Evaluation of the APACHE II and Modified APACHE II scoring systems"; Japanese College of Cardiology; 2019 (A)The prognosis, including all cause death , did not differ between the patients with an APACHE II score of ≤17 and those with an APACHE II score of ≥18 (B)The prognosis, including HF events , was significantly poorer in the patients with an APACHE II score of ≥18 tan in those with an APACHE II score of ≤17.

12. Okazaki, H.; "New scoring system (APACHE-HF) for predicting adverse outcomes in patients with acute heart failure: Evaluation of the APACHE II and Modified APACHE II scoring systems"; Japanese College of Cardiology; 2019

13. Okazaki, H.; "New scoring system (APACHE-HF) for predicting adverse outcomes in patients with acute heart failure: Evaluation of the APACHE II and Modified APACHE II scoring systems"; Japanese College of Cardiology; 2019 (C)The prognosis, including all -cause death , was significantly poorer in the patients with a Modified APACHE II score of ≥10 tan in those with a Modified APACHE II score of ≤9. (D)The prognosis, including HF events , was significantly poorer in the patients with a Modified APACHE II score of ≥10 tan in those with a Modified APACHE II score of ≤9.

14. Okazaki, H.; "New scoring system (APACHE-HF) for predicting adverse outcomes in patients with acute heart failure: Evaluation of the APACHE II and Modified APACHE II scoring systems"; Japanese College of Cardiology; 2019

15. Okazaki, H.; "New scoring system (APACHE-HF) for predicting adverse outcomes in patients with acute heart failure: Evaluation of the APACHE II and Modified APACHE II scoring systems"; Japanese College of Cardiology; 2019 (E)The prognosis, including all cause death , was significantly poorer in the patients with an APACHE-HF score of ≥3 tan in those with an APACHE II-HF score of ≤2. (F)The prognosis, including HF events , was significantly poorer in the patients with an APACHE-HF score of ≥3 tan in those with an APACHE II-HF score of ≤2.

16. Okazaki, H.; "New scoring system (APACHE-HF) for predicting adverse outcomes in patients with acute heart failure: Evaluation of the APACHE II and Modified APACHE II scoring systems"; Japanese College of Cardiology; 2019

17. Manejo preanestésico Uso de soluciones cristaloides balanceadas (30ml/kg en3 hrs) Vol. Latido>10-15% después de la infusión de 3 ml/kg en 5 min define un px respondedor > Tasis o > TAM > Presión de pulso >10% En ausencia de cambio iniciar apoyo vasopresor Evans, L., Rhodes, A., Alhazzani , W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47, 1181–1247 (2021). https://doi.org/10.1007/s00134-021-06506-y Carsetti,A .; et. al.; "Anesthetic Management of patients with sepsis and septic shock" Frontiers in Medicine, Intensive Care Medicine and Anesthesiology, Jan. 2023

18. Manejo preanestésico Determinación de la función cardiaca: buscar arritmias o cardiomiopatías sépticas -- 10 – 70% Inestabilidad hemodinámica e hipoperfusión Troponinas y BNP Mantener hemoglobina entre 7 y 9 g/dl Evans, L., Rhodes, A., Alhazzani , W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47, 1181–1247 (2021). https://doi.org/10.1007/s00134-021-06506-y Carsetti,A .; et. al.; "Anesthetic Management of patients with sepsis and septic shock" Frontiers in Medicine, Intensive Care Medicine and Anesthesiology, Jan. 2023

19. Evans, L., Rhodes, A., Alhazzani, W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47, 1181–1247 (2021). https://doi.org/10.1007/s00134-021-06506-y

20. Manejo preanestésico Función respiratoria: Aumento del trabajo ventilatorio + disnea – mecanismo compensatorio de acidosis matabolica SDRA – hipoxia Estudios de imagen y exploración son vitales Evans, L., Rhodes, A., Alhazzani , W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47, 1181–1247 (2021). https://doi.org/10.1007/s00134-021-06506-y Carsetti,A .; et. al.; "Anesthetic Management of patients with sepsis and septic shock" Frontiers in Medicine, Intensive Care Medicine and Anesthesiology, Jan. 2023

21. Manejo preanestésico Función renal: Sepsis / Choque séptico: LRA Determinar: Creatinina, Urea, Electrolitos y tasa urinaria Evans, L., Rhodes, A., Alhazzani , W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47, 1181–1247 (2021). https://doi.org/10.1007/s00134-021-06506-y Carsetti,A .; et. al.; "Anesthetic Management of patients with sepsis and septic shock" Frontiers in Medicine, Intensive Care Medicine and Anesthesiology, Jan. 2023

22. Evans, L., Rhodes, A., Alhazzani , W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47, 1181–1247 (2021). https://doi.org/10.1007/s00134-021-06506-y Carsetti,A .; et. al.; "Anesthetic Management of patients with sepsis and septic shock" Frontiers in Medicine, Intensive Care Medicine and Anesthesiology, Jan. 2023

23. El IS es la relación de 2 variables fisiológicas que reflejan el funcionamiento integral del sistema cardiovascular.

24. Manejo preanestésico Determinar la presencia de coagulopatía INR/TP y/o Trombocitopenia TEG/ROTEM CID + sangrado activo o alto riesgo de sangrado: PFC:10–15 mL /kg Hipofibrinogenemia: Crioprecipitados Plaquetas en sangrado activo Evans, L., Rhodes, A., Alhazzani , W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47, 1181–1247 (2021). https://doi.org/10.1007/s00134-021-06506-y Carsetti,A .; et. al.; "Anesthetic Management of patients with sepsis and septic shock" Frontiers in Medicine, Intensive Care Medicine and Anesthesiology, Jan. 2023 International Society on Thrombosis and Hemostasis

25. Evans, L., Rhodes, A., Alhazzani , W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47, 1181–1247 (2021). https://doi.org/10.1007/s00134-021-06506-y Carsetti,A .; et. al.; "Anesthetic Management of patients with sepsis and septic shock" Frontiers in Medicine, Intensive Care Medicine and Anesthesiology, Jan. 2023 ANTIBIOTICOTERAPIA < 1 HR posterior al DX Empírico según la región anatómica afectada y la epidemiología local, hasta tener cultivos Dependiendo de la duración del procedimiento considerar dosis subsecuentes

26. MANEJO INTRAOPERATORIO Intubación de secuencia rápida > sensibilidad hemodinámica y neurológica < dosis requeridas Línea arterial y catéter venoso central <CAM Evans, L., Rhodes, A., Alhazzani , W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47, 1181–1247 (2021). https://doi.org/10.1007/s00134-021-06506-y Carsetti,A .; et. al.; "Anesthetic Management of patients with sepsis and septic shock" Frontiers in Medicine, Intensive Care Medicine and Anesthesiology, Jan. 2023

27. MANEJO INTRAOPERATORIO Indicadores dinámicos de respuesta a fluidos: variabilidad de presión de pulso (PPV) y variabilidad de volumen latido (SVV) Vol. Tidal < 8 ml/kg Compliance bajo Norepinefrina y dobutamina gold standard Evans, L., Rhodes, A., Alhazzani , W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47, 1181–1247 (2021). https://doi.org/10.1007/s00134-021-06506-y Carsetti,A .; et. al.; "Anesthetic Management of patients with sepsis and septic shock" Frontiers in Medicine, Intensive Care Medicine and Anesthesiology, Jan. 2023 Un incremento del PPV o SVV de 3.5 y 2.5% respectivamente, después de > VT de 6 – 8 ml/kg = buena respuesta a volumen

28. MEDIDAS DE PROTECCIÓN EN VMI Vol. Tidal bajo 6-8 ml/kg del Peso Predicho < FiO2 para mantener SpO2 >94% Se beneficiaran de maniobras de reclutamiento Titular PEEP para buscar un driving pressure ( Pplat -PEEP) bajo Evans, L., Rhodes, A., Alhazzani , W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47, 1181–1247 (2021). https://doi.org/10.1007/s00134-021-06506-y Carsetti,A .; et. al.; "Anesthetic Management of patients with sepsis and septic shock" Frontiers in Medicine, Intensive Care Medicine and Anesthesiology, Jan. 2023

29. CONSIDERACIONES POSOPERATORIO Considerar admisión en UCI Requerimiento de apoyo sistémico Terapia de soporte ventilatorio y renal Evans, L., Rhodes, A., Alhazzani , W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47, 1181–1247 (2021). https://doi.org/10.1007/s00134-021-06506-y Carsetti,A .; et. al.; "Anesthetic Management of patients with sepsis and septic shock" Frontiers in Medicine, Intensive Care Medicine and Anesthesiology, Jan. 2023