Última revisión: 6 Nov 2020
Última actualización: 15 Oct 2018

Resumen

Definición

Anamnesis y exploración física

Factores clave de diagnóstico

  • presencia de factores de riesgo
  • temperatura alta (>38°C) o baja (<36°C)
  • taquicardia
  • taquipnea
  • alteración aguda del estado mental
  • llenado capilar deficiente, piel moteada o apariencia grisácea
  • signos asociados con una fuente de infección específica
  • baja saturación de oxígeno
  • hipotensión arterial
  • disminución de la diuresis
  • cianosis

Factores de riesgo

  • neoplasia maligna subyacente
  • edad >65 años
  • compromiso inmunológico
  • hemodiálisis
  • alcoholismo
  • diabetes mellitus
  • cirugía reciente u otros procedimientos invasivos
  • afectación de la integridad de la piel
  • vías o catéteres permanentes
  • abuso de drogas ilícitas por vía intravenosa
  • embarazo
  • residencia en centros urbanos
  • enfermedad pulmonar
  • sexo masculino
  • ascendencia no blanca
  • estación invernal

Pruebas diagnósticas

Primeras pruebas que solicitar

  • hemograma completo (HC) con diferencial
  • urea en sangre y electrolitos séricos
  • creatinina sérica
  • pruebas de función hepática (PFH)
  • estudios de coagulación (índice internacional normalizado [INR], tiempo de tromboplastina parcial activada [TTPa])
  • glucosa sérica
  • niveles de lactato
  • proteína C-reactiva
  • hemocultivo
  • otros cultivos (p. ej., de esputo, heces, orina, heridas, catéteres, implantes protésicos, áreas epidurales y líquido peritoneal o pleural)
  • gasometría arterial (GSA) o gasometría venosa (GSV)
  • radiografía de tórax
  • electrocardiograma (ECG)
Más primeras pruebas que solicitar

Pruebas que considerar

  • punción lumbar
  • ecocardiograma (transtorácico o transesofágico)
  • ultrasonido
  • TC de tórax o abdomen
  • procalcitonina sérica
Más pruebas que considerar

Algoritmo de tratamiento

Colaboradores

Chief Executive

United Kingdom Sepsis Trust

Chief Executive

Global Sepsis Alliance

Programme Director

Survive Sepsis

Consultant in Critical Care and Anaesthesia

Heart of England NHS Foundation Trust

Birmingham

UK

Conflicto de intereses

RD has received payment for consultancy on sepsis from Kimal Plc, manufacturers of vascular access devices, from the Northumbria Partnership, a patient safety collaborative, and, where annual leave or other income was compromised in fulfilling his charity duties, from the UK Sepsis Trust. RD has received sponsorship to attend and speak at one meeting from Abbott Diagnostics. He is CEO of the UK Sepsis Trust and Global Sepsis Alliance, and advises HM Government, the World Health Organisation and NHS England on sepsis. Each of these positions demands that he express opinion on strategies around the recognition and management of sepsis.

Consultant Acute Physician & Sepsis Lead

Department of Acute Medicine

Royal Hampshire County Hospital

Hampshire Hospitals NHS Foundation Trust

Winchester

UK

Conflicto de intereses

MIK is a national clinical advisor on sepsis to NHS England and a national clinical advisor on deterioration to NHS Improvement. He was reimbursed for a slide set by Relias Learning.

Specialty Registrar in Gastroenterology and General Medicine

Maidstone and Tunbridge Wells NHS Trust

UK

Conflicto de intereses

AS is the clinical fellow to the National Medical Director at NHS Improvement. AS has been sponsored on two occasions by Dr Falk Pharma UK to attend specialist gastroenterology conferences abroad; there was no contractual obligation to disseminate product information.

Consultant in Emergency Medicine

Clinical Academic

University of Plymouth

Lead Doctor

Devon Air Ambulance Trust

Derriford Hospital

Plymouth

UK

Conflicto de intereses

TN is a clinical adviser to the UK Sepsis Trust.

Specialty Registrar in Emergency Medicine

Derriford Hospital

Plymouth

UK

Conflicto de intereses

EC declares that he has no competing interests.

Dr Ron Daniels, Dr Matt Inada-Kimand, Dr Aamir Saifuddin, Dr Tim Nutbeam, and Dr Edward Berry would like to gratefully acknowledge Dr Lewys Richmond and Dr Paul Kempen, previous contributors to this topic. LR and PK declare that they have no competing interests.

Revisores paresVER TODO

Professor of Medicine

Infectious Disease Division

Rhode Island Hospital

Alpert Medical School of Brown University

Providence

RI

Conflicto de intereses

SMO declares that he has no competing interests.

Associate Professor

NYU School of Medicine

Medical Director of Critical Care

Bellevue Hospital Center

New York

NY

Conflicto de intereses

LE serves as the guidelines co-chair and on the steering committee of the Surviving Sepsis Campaign.

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