Mora RP, Núñez GP, Rodríguez ZC, Carbajal SR, Martínez DBA, Aguirre SJ

Language: Spanish
References: 13
Page: 245-250
PDF size: 290.37 Kb.

ABSTRACT

Introduction: septic shock is the most serious complication of sepsis with a high mortality rate, reaching up to 50% in some studies. Treatment for patients with septic shock includes multimodal use of crystalloids, vasopressors, antibiotics, and steroids. The evidence on the use of steroids in this population remains controversial due to the lack of standardization on the initiation of this drug in the context of septic shock. The initiation of this therapy as a complement was outlined in 2016 in the Surviving Sepsis Campaign guidelines. In the latest update on sepsis, the recommendation on starting hydrocortisone is made when, despite fluid and vasopressor therapy, they are not able to restore hemodynamic stability. The optimal dose, onset time and duration of steroid use remains uncertain. What is stated in the studies is when an average arterial pressure greater than 60 mmHg cannot be maintained for more than 4 or 6 hours. This does not preclude early use since in the context of shock this could occur after the first 24 hours. Therefore, it was decided to carry out this observational study to determine mortality in patients with early use of steroids in the intensive care unit. Objective: to determine whether the use of hydrocortisone in less than 12 hours in patients with septic shock reduces in-hospital and 28-day mortality. Material and methods: a retrospective, analytical, retroprolective and longitudinal study was carried out. Historical cohort. Patients with a diagnosis of septic shock of any etiology will be admitted. They were divided into groups according to the time of steroid initiation. Less than 12 hours or more than 12 hours. The data was collected from the electronic file. To analyze the data, the IBM SPSS system, version 29, was used. The collected data were organized and described in terms of descriptive statistics, the nominal and ordinal variables were described by absolute number and percentage; The numerical variables were described, depending on the type of distribution, with interval, mean and standard deviation, or with interval, median and percentiles, for the bivariate analysis Effect of peripheral maneuvers on the outcome, χ² or Fisher's exact test was used and the Multivariate analysis will analyze the association between early use of hydrocortisone (defined less than 12 hours) in patients with septic shock, adjusted for baseline state variables, peripheral variables; through Cox proportional hazards, with their HR and their respective 95% confidence intervals, or failing that, a logistic regression test will be applied. Results: the information of 70 patients with a diagnosis of septic shock and early use of hydrocortisone, < 12 hours vs > 12 hours, in the Intensive Care Unit of the ABC Medical Center during the period between the period between March 1, 2022 to August 31, 2023. The sample was made up of 51.4% (N = 36) and 48.6% of male patients (N = 34). Age showed a median of 70.41 years (IQR 62.70-83.25) with a range between 18 and 84 years. Within the origin of septic shock, it was found that the cause of septic shock was due to abdominal (38.6%) and pulmonary (34.6%) processes, mainly followed by urinary processes (21.4%). Mortality in the group using hydrocortisone for less than 12 hours was 14 of the 37 patients (37.8%) and in the group using hydrocortisone for more than 12 hours it was five of the 14 patients selected in this group (35.7%). Without statistical significance for mortality in the comparison of both groups (p = 0.92, CI 95% 0.7-1.3).

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