EL USO TEMPRANO DE ESTEROIDES EN LA SEPSIS SEVERA EVITA LLEGAR AL CHOQUE SÉPTICO O SU DURACIÓN EN TIEMPO DE ESTE Y MEJORA LA SOBREVIDA DEL PACIENTE CON SEPSIS CON MENOR TIEMPO DE USO DE AMINAS

Abstract

INTRODUCTION. Stressful situations that demand an increase of cortisol can cause adrenal insufficiency in critically ill patients presenting hypotension refractory to fluids, particularly in patients with severe sepsis or septic shock, in which there is a constant state of inflammation, in which overestimation the range of abnormalities, adrenal insufficiency may occur depending on the concentrations of protein (albumin). As early initiation of steroids decrease the presentation of septic shock or airtime amines. OBJECTIVES. Determine whether early use of steroids in patients with severe sepsis decreases the presentation of septic shock or time of use of amines as well as promotes a speedy recovery of the crash, and consequently could decrease mortality indirectly. So that would lead to decreased costs and better prognosis of patients with sepsis. MATERIAL AND METHODS. A study was conducted, observational, retrospective, in which 199 records were reviewed general hospital "Dr. Manuel Gea González ", provided by the division of biostatistics with a diagnosis of septicemia, which integrated the period January 2009 to December 2010, of which 7 were excluded because the age was less than that covered by the study and as 24 of which were not records, 10 that did not meet the criteria, and 22 of whom died. Are to be compared according to the response to steroid and no steroid improvement early or late, or no significant response to it. RESULTS. We obtained 136 patients of whom 88 met criteria for severe sepsis and 48 with septic shock, found that patients with serum albumin (<2.5mg/dl) are more predisposed to present severe sepsis or septic shock with 88% (p = 0.042), no relationship was found with lactate. Patients who developed severe sepsis and septic shock was 60.2%. There was no difference with the early use of steroids as it only will start in 17 patients and only 9 did not develop shock (p = 0.91), no early improvement was observed with the use of steroids for septic shock (p = 0.067) or in early use, as the number of cases was very small, it was not very significant recovery from the relationship of albumin level (p = 0.138). CONCLUSION. The early use of steroids in septic shock or at least this study did not report any improvement in the time of use of amines to be even lower in those who did not start, but is not conclusive whether the early use of steroids prevents early presentation of shock and was used only in 17 patients, of whom 9 are not developed, it would be necessary to conduct a pilot study to verify if there is a response to this treatment, which can be concluded is that there is no early improvement of the patient if initiated steroid or not in septic shock