2014, Number 2
Rev Hosp Jua Mex 2014; 81 (2)
Sepsis puerperal y reanimación guiada por metas. Experiencia en una Unidad de Cuidados Intensivos de un hospital de segundo nivel de atención
Hernández-López GD, Estrada-Carreón M, García-Román MTA, Gorordo-del Sol LA, Jiménez-Ruiz A, Tercero-Guevara BI
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Critically ill obstetric patient provides a challenge that requires a multidisciplinary approach. About
7/1,000 pregnant women require admission to the intensive care unit (ICU), with a mortality rate between 2.2 and
36%. Resuscitation guided by goals allowed to give basic life support and reduces the risk of death in the obstetric
patient with sepsis. Material and methods.
All patients admitted with obstetric pathology during January 2013 to
April 2014 period with sepsis diagnosis were included. Resuscitation was performed based on the algorithm
proposed by Rivers, modified according to the current guidelines for the management of sepsis. Noninvasive excluhemodynamic
monitoring was performed and the following variables were recorded: heart rate (HR), mean arterial
pressure (MAP), hourly diuresis (HD), temperature (T), central venous oxygen saturation (SCV
(Hb), central venous pressure (CV). Results.
Fifty-four critically ill obstetric patients were included, the average age
was 29 years. The average APACHE II score was 12 points at admission (mortality 15%), SOFA score average was
3 points (mortality ‹ 33%). The main cause for admission was hypertensive disease of pregnancy in 27 patients
(50 %), followed by hemorrhage obstetric in 15 (27.8 %) and sepsis in 12 (22.2 %). The main causes of infection were
urinary tract infection 5 (41.6 %), deciduitis 3 (25 %), surgical wound infection 2 (16.7%) and pneumonia in 2
(16.7%). No deaths were reported in the study group. Resuscitation goals were met in the first 6 h after sepsis
diagnosed. The mean ICU stay was 4.4 days, were no deaths in the study group. Conclusions.
The outcome and
survival of the obstetric patient review improve with early detection, prompt recognition of the condition that
prompted admission and appropriately targeted therapy.
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