Enfoque de la miocardiopatía séptica como causa de choque refractario en escenarios de recursos limitados: reporte de caso

Abstract

Worldwide, more than 18 million cases of sepsis are reported, which affects all age groups, with greater susceptibility in people at the extremes of life; within the wide debate on the definition of cardiomyopathy induced by sepsis, the depression of intrinsic contractility induced by sepsis is evident, and it is a common finding in patients with sepsis or septic shock in intensive care units; however, the inequity in the regional distribution of resources and the difficulties in achieving specialized medicine and diagnostic images in settings with limited resources make it necessary to socialize the challenges found in the management of critical patients in settings with limited resources, and reflect through of a case, the strategies that could have improved the outcome and demonstrate the need to provide tools as POCUS to all intensive care units, particularly in low and middle income countries with scenarios where the access to early diagnostic images by cardiology is limited. The inequity in the regional distribution of resources and the difficulties to achieve specialized medicine and diagnostic imaging in scenarios with limited access, make mandatory to socialize the challenges of critical patient management through a case in which the patient is admitted with septic shock of abdominal origin, high suspicion of cholangitis, electrocardiogram with sinus tachycardia, complete right branch block, ST depression in DI, abnormal R in V1, troponin negative, in which the patient is management with fluid resuscitation, vasopressor and inotropic support, empirical antibiotic management and anti-ischemic management; with progressive clinical deterioration, presenting ventilatory failure requiring invasive mechanical ventilation and requiring increased vasopressor support. Despite management, dynamic electrocardiographic changes associated with hypoperfusion persist. On the first day of ICU stay, the patient is in progressive multi-organ failure, with refractory septic shock, and finally the patient died. After the patient's death, blood cultures were reported with evidence of Escherichia coli ESBL. There are strategies that could have improved the outcome and evidenced the need to provide tools such as the critical POCUS to all intensive care units, particularly in low- and middle-income countries where early diagnostic imaging by cardiology is not available.