Shock séptico. Actualización en tratamiento con suero salino hipertónico y hormona antidiurética-vasopresina / Septic shock. Update of treatment using hypertonic saline and antidiuretic hormone-vasopressin

La seguridad en el uso del suero salino hipertónico ha sido comprobada por estudios en el campo de la reanimación con pequeños volúmenes para el shock hipovolémico y en el tratamiento de la hipertensión intracraneal. En el ámbito del shock séptico, ha sido poco experimentado en seres humanos. Existen efectos inmunomodulatorios beneficiosos detectados en estudios preclínicos. Las interacciones con el eje hipofisario-adrenal y con la secreción de la hormona antidiurética son diversas y sugerentes, pero insuficientemente entendidas. Por otra parte, la vasopresina ejerce acciones cardiovasculares, osmorreguladoras, sobre la coagulación y también sobre el eje hipotálamo-hipofisario-adrenal. En el shock séptico hay un déficit relativo de vasopresina. Su uso en estos pacientes no parece presentar ventajas en cuanto a la mortalidad, pero puede ser beneficioso en pacientes en riesgo de insuficiencia renal aguda o en aquellos que reciben corticoides. La terlipresina es un análogo de la vasopresina que también se ha estudiado. La sinergia entre la vasopresina y el suero salino hipertónico es una hipótesis que se fundamenta, sobre todo, en estudios preclínicos. El uso del suero salino hipertónico en el shock séptico sigue siendo experimental, aunque prometedor, y debe quedar restringido al campo de los ensayos clínicos controlados(AU)

Safety in the use of small volumes of hypertonic saline solution for hypovolaemic shock and in the treatment of intracranial hypertension has been demonstrated in studies in the field of resuscitation. There is little experience of this for septic shock in humans. Beneficial immunomodulatory effects have been detected in pre-clinical studies. Interactions with the pituitary-adrenal axis and with the secretion of anti-diuretic hormone are varied and suggestive, but are not sufficiently understood. On the other hand, vasopressin has cardiovascular, osmoregulatory, and coagulation effects, and also acts on the hypothalamic-pituitary-adrenal axis. There is a relative deficit of vasopressin in septic shock. Its use in these patients does seem to have any advantages as regards mortality, but may be beneficial in patients at risk from acute renal failure, or those who receive corticosteroids. Terlipressin is a vasopressin analogue that has also been studied. The synergy between vasopressin and hypertonic saline is a hypothesis that is mainly supported in pre-clinical studies. The use of hypertonic saline solution in septic shock, although promising, is still experimental, and must be restricted to the field of controlled clinical trials(AU)

[Septic shock. Update of treatment using hypertonic saline and antidiuretic hormone-vasopressin]. / Shock séptico. Actualización en tratamiento con suero salino hipertónico y hormona antidiurética-vasopresina.

Safety in the use of small volumes of hypertonic saline solution for hypovolaemic shock and in the treatment of intracranial hypertension has been demonstrated in studies in the field of resuscitation. There is little experience of this for septic shock in humans. Beneficial immunomodulatory effects have been detected in pre-clinical studies. Interactions with the pituitary-adrenal axis and with the secretion of anti-diuretic hormone are varied and suggestive, but are not sufficiently understood. On the other hand, vasopressin has cardiovascular, osmoregulatory, and coagulation effects, and also acts on the hypothalamic-pituitary-adrenal axis. There is a relative deficit of vasopressin in septic shock. Its use in these patients does not seem to have any advantages as regards mortality, but may be beneficial in patients at risk from acute renal failure, or those who receive corticosteroids. Terlipressin is a vasopressin analogue that has also been studied. The synergy between vasopressin and hypertonic saline is a hypothesis that is mainly supported in pre-clinical studies. The use of hypertonic saline solution in septic shock, although promising, is still experimental, and must be restricted to the field of controlled clinical trials.

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