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Sepse em adultos

Última revisão: 25 Jun 2024
Última atualização: 26 Jul 2023

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presença de fatores de risco
  • temperatura alta (>38 °C) ou baixa (<36 °C)
  • taquicardia
  • taquipneia
  • estado mental alterado agudamente
  • enchimento capilar lentificado, pele com manchas vermelhas e roxas variadas ou com aspecto acinzentado
  • sinais associados à causa específica de infecção
  • baixa saturação de oxigênio
  • hipotensão arterial
  • débito urinário diminuído
  • cianose
Detalhes completos

Outros fatores diagnósticos

  • púrpura fulminante
  • icterícia
  • íleo paralítico
Detalhes completos

Fatores de risco

  • idade >65 anos
  • imunocomprometimento
  • sondas intravenosas ou vesicais de demora
  • cirurgia recente ou outros procedimentos invasivos
  • hemodiálise
  • diabetes mellitus
  • uso de substâncias por via intravenosa
  • transtornos decorrentes do uso de bebidas alcoólicas
  • integridade cutânea prejudicada
  • gestação
  • residência em área urbana
  • doença pulmonar
  • sexo masculino
  • ascendência não branca
  • estação do inverno
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • hemocultura
  • níveis de lactato
  • Hemograma completo com diferencial
  • ureia sanguínea e eletrólitos séricos
  • creatinina sérica
  • testes da função hepática
  • estudos de coagulação (razão normalizada internacional [INR], tempo de tromboplastina parcial [TTP] ativada)
  • glicose sérica
  • proteína C-reativa
  • outras culturas (por exemplo, de escarro, fezes, urina, feridas, cateteres, implantes protéticos, locais epidurais, líquido pleural ou peritoneal)
  • gasometria arterial ou venosa
  • radiografia torácica
  • eletrocardiograma (ECG)
Detalhes completos

Investigações a serem consideradas

  • punção lombar
  • ecocardiografia (transtorácica ou transesofágica)
  • ultrassonografia
  • TC de tórax ou abdome
  • procalcitonina sérica
Detalhes completos

Algoritmo de tratamento

Aguda

sepse presumida ou confirmada

Colaboradores

Autores

Andre C. Kalil, MD, MPH, FACP, FIDSA, FCCM

Professor

Department of Internal Medicine

Division of Infectious Diseases

University of Nebraska Medical Center

Omaha

NE

Declarações

ACK declares that he has no competing interests.

Kelly Cawcutt, MD, MS, FACP, FIDSA, FCCM

Associate Professor

Department of Internal Medicine

Division of Pulmonary, Critical Care, Sleep & Allergy

University of Nebraska Medical Center

Omaha

NE

Declarações

KC has received payment for medical writing from IDSA and CloroxPro. KC has received honoraria for creation of educational materials from the Society for Healthcare Epidemiology of America (SHEA) and payment from BD. KC has received honoraria and travel expenses from NAPA. KC has received payment for book proposal review from Elsevier.

Agradecimentos

Professor Andre Kalil and Dr Kelly Cawcutt would like to gratefully acknowledge Dr Ron Daniels, Dr Matt Inada-Kim, Dr Aamir Saifuddin, Dr Tim Nutbeam, Dr Edward Berry, Dr Lewys Richmond, and Dr Paul Kempen, previous contributors to this topic.

Declarações

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 Organization, and NHS England on sepsis. Each of these positions demands that he express opinion on strategies around the recognition and management of sepsis. 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. 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. TN is a clinical adviser to the UK Sepsis Trust. EB, LR, and PK declare that they have no competing interests.

Revisores

Steven M. Opal, MD, FIDSA

Professor of Medicine

Infectious Disease Division

Rhode Island Hospital

Alpert Medical School of Brown University

Providence

RI

Declarações

SMO declares that he has no competing interests.

Laura Evans, MD, MSc, FCCP, FCCM

Associate Professor

NYU School of Medicine

Medical Director of Critical Care

Bellevue Hospital Center

New York

NY

Declarações

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

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