Open AccessShock séptico en la Unidad de Cuidados Intensivos. Terapéutica avanzada, inmunoparálisis y genómica. Estado del arte
Author(s) -
Daniela Arriagada S,
Alejandro Donoso F,
Pablo Cruces R,
Franco Díaz R
Publication year - 2014
Publication title -
archivos argentinos de pediatría
Language(s) - Spanish
Resource type - Journals
eISSN - 1668-3501
pISSN - 0325-0075
DOI - 10.5546/aap.2014.358
Subject(s) - medicine , septic shock , plasmapheresis , renal replacement therapy , intensive care unit , intensive care medicine , extracorporeal , hemofiltration , critically ill , intensive care , sepsis , immunology , hemodialysis , antibody
New and important concepts have emerged for the advanced management of the child with septic shock in the recent decades. Attending physicians in the Pediatric intensive care unit must be fully aware of them to improve patient care in the critical care unit. It should be considered the use of immune therapy only in selected groups of patients. Continuous renal replacement therapies are well tolerated and their early use prevents deleterious fluid overload. Removal of inflammatory mediators by using high volume hemofiltration may play a role in hyperdynamic septic patients. The use of plasmapheresis is recommended in patients with thrombocytopenia-associated multiple organ failure. Extracorporeal support use should be considered in those with refractory septic shock despite goals directed therapy. The immunoparalysis has been associated with nosocomial infections and late mortality. The information from genetic markers may allow early intervention and preventive genomics-based medicine.