Efecto de los vasopresores sobre la función renal y cardíaca en pacientes con shock séptico

Septic shock is a syndrome characterized by tissue hypoperfusion and persistent hypotension that does not respond to fluid supply, and this is secondary to an uncontrolled infection. It is a frequent cause of admission to the intensive care unit and its mortality risk is variable.

The origin of septic shock can have various etiologies and different responsible microorganisms such as bacteria, viruses or fungi, with variable complications depending on the affected parenchyma.

Tissue hypoperfusion is present in patients with septic shock due to several mechanisms that include systemic vasodilation, relative hypovolemia, macro and microcirculatory endothelial dysfunction and low blood pressure with altered global perfusion pressure. Classically, septic shock has been described as a hyperdynamic state, with increased cardiac output and decreased systemic vascular resistance, which makes arterial hypotension in many cases refractory to management with fluids alone. When myocardial depression occurs, which many authors have called septic heart disease, the state of hypoperfusion worsens and increases mortality. From the renal point of view, it generates acute kidney injury, which is one of the main complications associated with septic shock, increasing the risk of mortality, and between 30 and 40% will require renal replacement therapy.

Hemodynamic treatment of septic shock is aimed at maintaining oxygen supply above a critical threshold, while maintaining a mean arterial pressure at a level that allows adequate organ perfusion.