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Advisor(s)
Abstract(s)
Introdução: O Choque Séptico é uma condição frequente, comprometedora do estado de saúde
do hospedeiro, que leva à falência de órgãos. Um dos órgãos afetado é o coração. A
Cardiomiopatia Séptica apresenta elevada mortalidade e morbilidade. O desconhecimento desta
condição, põe em causa o diagnóstico e tratamento adequados.
Objetivos: Esta dissertação aborda o estado da arte da falência cardíaca, como componente da
falência multiorgânica do choque séptico. Procura esclarecer a fisiopatologia, a terapêutica e o
diagnóstico desta condição; pondo em evidência dilemas diagnósticos e terapêuticos.
Materiais e métodos: Foi realizada uma pesquisa da literatura cíentifica publicada em Inglês,
Português e Espanhol, entre Setembro e Novembro de 2019. Recorreu-se à base de dados
PubMed, com as palavras chave: acute heart failure, septic shock, multiple organ dysfunction;
por separado e cruzadas a posteriori; dos últimos cinco anos, em Humanos. Em simultãneo foram
pesquisados artigos científicos e livros de livre acesso na web, sem restrição de tempo. Os artigos
foram selecionados tendo em conta a pertinência face ao tema, se o título e/ou resumo indiciava
esclarecer o tema; e por crítério de seleção pessoal. Reuniram-se 66 artigos científicos que
cumpriram os critérios de inclusão.
Desenvolvimento: Com uma incidência de 18-65% e mortalidade de 40-70%, a Cardiomiopatia
Séptica é a falência de órgão mais difícil de caracterizar. É uma síndrome aguda que se
caracteriza por uma depressão miocárdica intrínseca reversível, disfunção ventricular, e
alterações da função sistólica e diastólica. A Falência Sistólica do VE é a mais frequente e a
Falência Diastólica apresenta correlação com a mortalidade e prognostico. A Falência Sistólica do
VD associa-se com a Síndrome da Dificuldade Respiratória Aguda (SDRA) e é escassa a informação
relativa à Falência Diastólica do VD. Apresenta uma fisiopatologia intrincada com uma resposta
miocárdica inflamatória complexa. Exige monitorização hemodinâmica, marcadores cardíacos e
exames complementares de imagem. A Speckle tracking echocardiography é uma inovação
significativa cardiomiopatia séptica. O tratamento passa pela administração de fluidos
balanceados e Norepinefrina como primeira eleição. Dopamina para casos específicos e ECMO
aquando refratariedade.
Conclusão: Moléculas e marcadores cardíacos específicos podem permitir um diagnóstico e
terapêutica atempada, num futuro próximo. É crucial a realização de mais investigações clínicas
e experimentais e é prementes a criação de diretrizes mais específicas, que guiem os
profissionais de saúde na abordagem desta patologia.
Introduction: Septic shock is a frequent condition that compromises the health status of the host, leading to organ failure. One of the affected organs is the heart. Septic cardiomyopathy has high mortality and morbidity. The lack of knowledge about this condition puts in question the diagnosis and treatment used. Objectives: This dissertation addresses the state-of-the-art of heart failure as a component of multiorgan failure in septic shock. Seek to explore the pathophysiology, the diagnosis and therapeutic approach of this condition; highlighting the diagnostic and therapeutic dilemmas. Materials and methods: A research of the scientific literature published in English, Portuguese and Spanish between September and November 2019 was performed. The PubMed database was used with the keywords: acute heart failure, septic shock, multiple organ dysfunction; separately and crossed; of the last five years in Humans. At the same time, scientific articles and open access books on the web were searched, without time restriction. The articles were selected considering their relevance to the theme, if the title and/or abstract indicated that the topic was clarified; and by criteria of personal selection. Sixty-six scientific articles that met the inclusion criteria were gathered. Development: With an incidence of 18-65% and mortality of 40-70%, Septic Cardiomyopathy is the most difficult organ failure to characterize. It is an acute syndrome characterized by reversible intrinsic myocardial depression, ventricular dysfunction, and changes in systolic and diastolic function. LV systolic failure is the most frequent and diastolic failure correlates with mortality and prognosis. RV Systolic Failure is associated with Acute Respiratory Distress Syndrome (ARDS) and information on RV Diastolic Failure is scarce. It has an intricate pathophysiology with a complex inflammatory myocardial response. It requires hemodynamic monitoring, cardiac markers and complementary imaging exams. Speckle tracking echocardiography is a significant innovation in septic cardiomyopathy. Treatment involves the administration of balanced fluids and Norepinephrine as the first choice. Dopamine for specific cases and ECMO for refractory shock. Conclusion: Specific cardiac molecules and markers may allow early diagnosis and therapy in the near future. Further clinical and experimental research is crucial and more specific guidelines are needed to guide health professionals in addressing this pathology.
Introduction: Septic shock is a frequent condition that compromises the health status of the host, leading to organ failure. One of the affected organs is the heart. Septic cardiomyopathy has high mortality and morbidity. The lack of knowledge about this condition puts in question the diagnosis and treatment used. Objectives: This dissertation addresses the state-of-the-art of heart failure as a component of multiorgan failure in septic shock. Seek to explore the pathophysiology, the diagnosis and therapeutic approach of this condition; highlighting the diagnostic and therapeutic dilemmas. Materials and methods: A research of the scientific literature published in English, Portuguese and Spanish between September and November 2019 was performed. The PubMed database was used with the keywords: acute heart failure, septic shock, multiple organ dysfunction; separately and crossed; of the last five years in Humans. At the same time, scientific articles and open access books on the web were searched, without time restriction. The articles were selected considering their relevance to the theme, if the title and/or abstract indicated that the topic was clarified; and by criteria of personal selection. Sixty-six scientific articles that met the inclusion criteria were gathered. Development: With an incidence of 18-65% and mortality of 40-70%, Septic Cardiomyopathy is the most difficult organ failure to characterize. It is an acute syndrome characterized by reversible intrinsic myocardial depression, ventricular dysfunction, and changes in systolic and diastolic function. LV systolic failure is the most frequent and diastolic failure correlates with mortality and prognosis. RV Systolic Failure is associated with Acute Respiratory Distress Syndrome (ARDS) and information on RV Diastolic Failure is scarce. It has an intricate pathophysiology with a complex inflammatory myocardial response. It requires hemodynamic monitoring, cardiac markers and complementary imaging exams. Speckle tracking echocardiography is a significant innovation in septic cardiomyopathy. Treatment involves the administration of balanced fluids and Norepinephrine as the first choice. Dopamine for specific cases and ECMO for refractory shock. Conclusion: Specific cardiac molecules and markers may allow early diagnosis and therapy in the near future. Further clinical and experimental research is crucial and more specific guidelines are needed to guide health professionals in addressing this pathology.
Description
Keywords
Choque Séptico Falência Multiorganica Insuficiência Cardíaca Aguda