Alteraciones hemodinámicas en pacientes con sepsis grave visualizadas por ecocardiografía, reporte de casos clínicos.
Resumen
Introducción: las alteraciones hemodinámicas presentadas en los pacientes con sepsis grave son varias, entre estas podemos nombrar a la depresión miocárdica, la dilatación biventricular y la disminución de la fracción de eyección, tanto del ventrículo derecho como izquierdo; aunque la fsiopatología de la disfunción cardiaca es complicada sabemos que entre estos están involucrados mecanismos infamatorios metabólicos y de señalización intracelular relacionados al movimiento del calcio, del receptor de rianodina y a una alteración en la producción de óxido nítrico además de la IL1 y el TNF. La depresión miocárdica secundaria a sepsis es independiente de reanimación con volumen, la cual se normaliza entre el séptimo a décimo día, El uso racional de los líquidos y el inicio de vasoactivos e inotrópicos son fundamentales para su manejo. La ecocardiografía puede proporcionar un rápido diagnóstico confirmatorio de la sospecha clínica. Actualmente, la ecocardiografía se considera una indicación actual en todo paciente hemodinámicamente inestable, y puede obtenerse información relacionada con anormalidades de la estructura y función, que puede facilitar la investigación de isquemia miocárdica, disfunción valvular y patología pericárdica, proporcionando un rápido diagnostico confirmatorio de la sospecha clínica. Teniendo en cuenta que los pacientes que ingresan a las unidades de cuidados intensivos en su mayoría no son previamente sanos y presentan alteraciones funcionales a nivel cardiaco, la valoración hemodinámica avanzada para guiar el plan de tratamiento es indispensable y personalizado. Caso: a continuación describimos una serie de casos en los que la valoración hemodinámica avanzada a través de la ecocardiografía proporcionó una guía para el manejo y resolución del problema.
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