Algoritmo de tratamiento

Tenga en cuenta que las formulaciones/vías y dosis pueden diferir entre los nombres y marcas de los fármacos, las fórmulas de los fármacos o las localizaciones. Las recomendaciones de tratamiento son específicas para cada grupo de pacientes: ver aviso legal

Inicial

sepsis of unknown cause

Primera línea – admission to intensive care unit (ICU), empiric antimicrobial therapy, and supportive therapy

Back
Inicial
|
sepsis of unknown cause
Primera línea – 

admission to intensive care unit (ICU), empiric antimicrobial therapy, and supportive therapy

Hantavirus cardiopulmonary syndrome (HCPS) can progress rapidly to cardiogenic shock and death and must be managed in an ICU.[51][66]​​[74]​​​

Empiric antimicrobial therapy for sepsis is appropriate until the diagnosis of HCPS is made. Local protocols and guidelines should be followed. Once the diagnosis is made, antibiotics should be discontinued. See Sepsis in adults and Sepsis in children.

Analgesia and antipyretics may be given while awaiting confirmation of diagnosis.

más – infection prevention and control

Back
Inicial
|
sepsis of unknown cause
más – 

infection prevention and control

Se recomienda el tratamiento para TODOS LOS pacientes en el grupo de pacientes seleccionados

Standard precautions are recommended when managing all patients with hantavirus infection.[55]​[56] 

Human-to-human transmission has been reported rarely with Andes virus (ANDV). If ANDV infection is suspected or confirmed, the patient should be placed in an isolation room, and contact and airborne precautions are recommended including use of a gown, eye protection, and a N95 (or higher-level) respirator when entering the patient’s room. Duration of precautions should be determined on a case-by-case basis in conjunction with local public health authorities.[6]​[57] 

Agudo

confirmed hantavirus infection

Primera línea – intensive supportive care

Back
Agudo
|
confirmed hantavirus infection
Primera línea – 

intensive supportive care

Hantavirus cardiopulmonary syndrome (HCPS) can progress rapidly to cardiogenic shock and death and must be managed in an ICU.[51][66]​​[74]

If empiric antibiotics were started, they may be discontinued once a diagnosis of hantavirus infection is made.

Supplemental oxygen and intubation and mechanical ventilation for respiratory support may be required.[74]​ About 40% of patients admitted to the hospital will not require intubation and can be managed with supplemental oxygen and careful fluid administration.[10] Intubated survivors can usually be extubated within 1 week.[10]

Fluids should be given cautiously so as not to accelerate the development of pulmonary edema.[74]

Vasoactive agents may be required for cardiogenic shock. Dobutamine plus norepinephrine (noradrenaline) has been suggested as an effective regimen.[64][74]​ Dose should be started low and titrated according to response. Consult your local protocols for guidance on choice of regimen and dose.

Platelet transfusion may be required according to local protocols.[74]

Experimental therapies may be used during outbreaks.

más – infection prevention and control

Back
Agudo
|
confirmed hantavirus infection
más – 

infection prevention and control

Se recomienda el tratamiento para TODOS LOS pacientes en el grupo de pacientes seleccionados

Standard precautions are recommended when managing all patients with hantavirus infection.[55]​[56] 

Human-to-human transmission has been reported rarely with Andes virus (ANDV). If ANDV infection is suspected or confirmed, the patient should be placed in an isolation room, and contact and airborne precautions are recommended including use of a gown, eye protection, and a N95 (or higher-level) respirator when entering the patient’s room. Duration of precautions should be determined on a case-by-case basis in conjunction with local public health authorities.[6]​[57]

Considerar – extracorporeal membrane oxygenation (ECMO)

Back
Agudo
|
confirmed hantavirus infection
Considerar – 

extracorporeal membrane oxygenation (ECMO)

Tratamiento adicional recomendado para ALGUNOS pacientes del grupo seleccionado

Early consideration of transfer to a center with ECMO access is key. A falling cardiac index with evidence of cardiovascular collapse is an indication for ECMO support.[64]

Studies suggest that up to 72% of hantavirus cardiopulmonary syndrome (HCPS) patients with high mortality risk supported with ECMO have survived to hospital discharge.[64][82]

Features indicating high mortality risk include: a cardiac index <2.5 L/minute/m²; serum lactate >4 mmol/L; cardiac arrhythmia (ventricular fibrillation, tachycardia, or pulseless electrical dissociation); shock refractory to fluids; and vasoactive therapy.[73]

back arrow

Seleccione un grupo de pacientes para consultar nuestras recomendaciones

Tenga en cuenta que las formulaciones/vías y dosis pueden diferir entre los nombres y marcas de los fármacos, las fórmulas de los fármacos o las localizaciones. Las recomendaciones de tratamiento son específicas para cada grupo de pacientes. Véase el descargo de responsabilidad

El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad