Sepsis abdominal: enfoque integrado desde quirófano a UCI Abdominal sepsis: an integrated approach from the operating room to the ICU
Resumen
Objetivo: Sintetizar de forma crítica y actualizada la evidencia científica sobre la fisiopatología, el diagnóstico, el control de foco quirúrgico y el manejo intensivista de la sepsis abdominal, con énfasis en la articulación quirófano-UCI, los principios de la antibioticoterapia guiada por farmacología clínica, las terapias emergentes y la aplicabilidad en el sistema de salud latinoamericano. Fuentes: Revisión narrativa de literatura publicada entre 2015 y 2026 en PubMed/MEDLINE, Cochrane Library, EMBASE y LILACS. Se priorizaron ensayos clínicos aleatorizados, metaanálisis y guías de la Surviving Sepsis Campaign 2021, WSES 2021, Surgical Infection Society, y Tokyo Guidelines 2018. Resultados clave: La sepsis abdominal representa el 20–30% de los ingresos a UCI quirúrgica en América Latina, con mortalidad hospitalaria del 23–47% según gravedad. El control de foco quirúrgico dentro de las primeras 6 horas reduce la mortalidad de forma independiente (OR 0.42; IC95% 0.28–0.63). La antibioticoterapia empírica adecuada iniciada en la primera hora reduce la mortalidad un 7–10% por cada hora de retraso. La resistencia por BLEE (>35% en Colombia, WHONET 2023) y carbapenemasas en ascenso modifica los esquemas empíricos regionales. Las terapias emergentes —hemoadsorción, inmunomodulación, inteligencia artificial predictiva— muestran señales prometedoras pendientes de validación. Conclusiones: El manejo óptimo exige integración multidisciplinaria quirúrgica-intensivista-infectológica estructurada en cinco pilares: reconocimiento temprano, control de foco oportuno, antibioticoterapia dirigida por farmacología clínica, reanimación guiada por fases y soporte orgánico protector. La implementación de protocolos institucionalizados y herramientas digitales de apoyo a la decisión clínica representa la estrategia con mayor potencial de reducir la mortalidad evitable en contextos latinoamericanos.
Descargas
Citas
Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–810.
Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Med. 2021;47(11):1181–1247.
Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200–211.
Sartelli M, et al. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines. World J Emerg Surg. 2017;12:29.
Sartelli M, Weber DG, Ruppé E, et al. Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA). World J Emerg Surg. 2016;11:33.
Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infections in adults and children: guidelines by SIS and IDSA. Clin Infect Dis. 2010;50(2):133–164.
Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from WSACS. Intensive Care Med. 2013;39(7):1190–1206.
Reintam Blaser A, Starkopf J, Alhazzani W, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017;43(3):380–398.
Bellomo R, Kellum JA, Ronco C, et al. Acute kidney injury in sepsis. Intensive Care Med. 2017;43(6):816–828.
Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome (PROSEVA). N Engl J Med. 2013;368(23):2159–2168.
Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372(8):747–755.
Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring: task force of the ESICM. Intensive Care Med. 2014;40(12):1795–1815.
Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–1596.
Malbrain ML, Marik PE, Witters I, et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients. Anaesthesiol Intensive Ther. 2014;46(5):361–380.
Kellum JA, Lameire N; KDIGO AKI Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary. Crit Care. 2013;17(1):204.
De Backer D, Aldecoa C, Njimi H, Vincent JL. Dopamine versus norepinephrine in the treatment of septic shock. Crit Care Med. 2012;40(3):725–730.
Annane D, Renault A, Brun-Buisson C, et al. Hydrocortisone plus fludrocortisone for adults with septic shock (APROCCHSS). N Engl J Med. 2018;378(9):809–818.
Venkatesh B, Finfer S, Cohen J, et al. Adjunctive glucocorticoid therapy in patients with septic shock (ADRENAL). N Engl J Med. 2018;378(9):797–808.
Khanna A, English SW, Wang XS, et al. Angiotensin II for the treatment of vasodilatory shock (ATHOS-3). N Engl J Med. 2017;377(5):419–430.
Coopersmith CM, De Backer D, Deutschman CS, et al. Surviving Sepsis Campaign: research priorities for sepsis and septic shock. Intensive Care Med. 2018;44(9):1400–1426.
Reyes LF, Muriel-Bomba L, Fuentes YV, et al. Epidemiología de la sepsis y el shock séptico en unidades de cuidados intensivos de Colombia. Med Intensiva. 2021;45(7):410–418.
Sartelli M, Abu-Zidan FM, Ansaloni L, et al. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper. World J Emerg Surg. 2015;10:35.
Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22(7):707–710.
Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019;14:27.
Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. BMJ. 2016;353:i1585.
The STARRT-AKI Investigators. Timing of initiation of renal-replacement therapy in acute kidney injury. N Engl J Med. 2020;383(3):240–251.
Moreno RP, Metnitz PG, Almeida E, et al. SAPS 3—From evaluation of the patient to evaluation of the intensive care unit. Intensive Care Med. 2005;31(10):1345–1355.
Sartelli M, Catena F, Ansaloni L, et al. Complicated intra-abdominal infections in Europe: the CIAO Study. World J Emerg Surg. 2012;7(1):36.
Sartelli M, Coccolini F, Kluger Y, et al. WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with intra-abdominal infections. World J Emerg Surg. 2021;16(1):49.
WHO. Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report 2022. Geneva: World Health Organization; 2022.
Instituto Nacional de Salud, Colombia. Informe de resistencia antimicrobiana 2023. Red Nacional de Laboratorios — WHONET Colombia. Bogotá: INS; 2023.
Fagon JY, Chastre J, Vuagnat A, et al. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA. 1996;275(11):866–869.
ARMA Study Group. Ventilation with lower tidal volumes for acute lung injury and ARDS. N Engl J Med. 2000;342(18):1301–1308.
Gupta S, Sakhuja A, Kumar G, et al. Culture-negative severe sepsis: nationwide trends and outcomes. Chest. 2016;150(6):1251–1259.
Vincent JL, Marshall JC, Namendys-Silva SA, et al. Assessment of the worldwide burden of critical illness: the ICON audit. Lancet Respir Med. 2014;2(5):380–386.
Heuer JF, Crozier TA, Howard G, et al. Sepsis and mechanisms of inflammatory response. Eur J Anaesthesiol. 2011;28(7):479–488.
Townsend SR, Schorr C, Levy MM, Dellinger RP. Reducing mortality in severe sepsis: the surviving sepsis campaign. Clin Chest Med. 2008;29(4):721–733.
Kimura T, Umegaki T, Shinoda Y, et al. Damage control surgery for abdominal sepsis: an update. J Intensive Care. 2022;10(1):4.
De Waele JJ, Leppäniemi AK. Intra-abdominal hypertension in acute pancreatitis. World J Surg. 2009;33(6):1128–1133.
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546–1554.
Derechos de autor 2026 Marlon Jesus Lozano Moreno , Mayerly Lizeth Herrera Ruiz, Liliana Cristina Diaz Cruz, Ana María Sandoval Restrepo, María Mercedes Coronado Movilla , Andersson Enrique Pedraza Rojas , Yeison Jose Muñoz Cala , Jorge Eduardo Vega Parra , María Isabela Gómez Lopez , Ana Lucía Gómez López, Yusneht Grein Castrillon Moscote , Leidy Paola Torres Chaparro , Laritza Johana Perez Ardila
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
.png)
.png)
1.png)
