<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2448-8909</journal-id>
<journal-title><![CDATA[Medicina crítica (Colegio Mexicano de Medicina Crítica)]]></journal-title>
<abbrev-journal-title><![CDATA[Med. crít. (Col. Mex. Med. Crít.)]]></abbrev-journal-title>
<issn>2448-8909</issn>
<publisher>
<publisher-name><![CDATA[Colegio Mexicano de Medicina Crítica A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2448-89092024000400245</article-id>
<article-id pub-id-type="doi">10.35366/118214</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Uso temprano de hidrocortisona para la disminución de mortalidad en pacientes con choque séptico]]></article-title>
<article-title xml:lang="en"><![CDATA[Early use of hydrocortisone to reduce mortality in patients with septic shock]]></article-title>
<article-title xml:lang="pt"><![CDATA[Uso precoce de hidrocortisona para reduzir a mortalidade em pacientes com choque séptico]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mora Ruiz]]></surname>
<given-names><![CDATA[Pablo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Núñez González]]></surname>
<given-names><![CDATA[Pablo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez Zárate]]></surname>
<given-names><![CDATA[Cecilia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Carbajal Serrano]]></surname>
<given-names><![CDATA[Reyna]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martínez Díaz]]></surname>
<given-names><![CDATA[Braulia Aurelia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Aguirre Sánchez]]></surname>
<given-names><![CDATA[Janet]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Médico ABC  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<volume>38</volume>
<numero>4</numero>
<fpage>245</fpage>
<lpage>250</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2448-89092024000400245&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2448-89092024000400245&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2448-89092024000400245&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[resumen está disponible en el texto completo]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  septic shock is the most serious complication of sepsis with a high mortality rate, reaching up to 50% in some studies. Treatment for patients with septic shock includes multimodal use of crystalloids, vasopressors, antibiotics, and steroids. The evidence on the use of steroids in this population remains controversial due to the lack of standardization on the initiation of this drug in the context of septic shock. The initiation of this therapy as a complement was outlined in 2016 in the Surviving Sepsis Campaign guidelines. In the latest update on sepsis, the recommendation on starting hydrocortisone is made when, despite fluid and vasopressor therapy, they are not able to restore hemodynamic stability. The optimal dose, onset time and duration of steroid use remains uncertain. What is stated in the studies is when an average arterial pressure greater than 60 mmHg cannot be maintained for more than 4 or 6 hours. This does not preclude early use since in the context of shock this could occur after the first 24 hours. Therefore, it was decided to carry out this observational study to determine mortality in patients with early use of steroids in the intensive care unit.  Objective:  to determine whether the use of hydrocortisone in less than 12 hours in patients with septic shock reduces in-hospital and 28-day mortality.  Material and methods:  a retrospective, analytical, retroprolective and longitudinal study was carried out. Historical cohort. Patients with a diagnosis of septic shock of any etiology will be admitted. They were divided into groups according to the time of steroid initiation. Less than 12 hours or more than 12 hours. The data was collected from the electronic file. To analyze the data, the IBM SPSS system, version 29, was used. The collected data were organized and described in terms of descriptive statistics, the nominal and ordinal variables were described by absolute number and percentage; The numerical variables were described, depending on the type of distribution, with interval, mean and standard deviation, or with interval, median and percentiles, for the bivariate analysis Effect of peripheral maneuvers on the outcome, &#967;2 or Fisher&#8217;s exact test was used and the Multivariate analysis will analyze the association between early use of hydrocortisone (defined less than 12 hours) in patients with septic shock, adjusted for baseline state variables, peripheral variables; through Cox proportional hazards, with their HR and their respective 95% confidence intervals, or failing that, a logistic regression test will be applied.  Results:  the information of 70 patients with a diagnosis of septic shock and early use of hydrocortisone, &lt; 12 hours vs &gt; 12 hours, in the Intensive Care Unit of the ABC Medical Center during the period between the period between March 1, 2022 to August 31, 2023. The sample was made up of 51.4% (N = 36) and 48.6% of male patients (N = 34). Age showed a median of 70.41 years (IQR 62.70-83.25) with a range between 18 and 84 years. Within the origin of septic shock, it was found that the cause of septic shock was due to abdominal (38.6%) and pulmonary (34.6%) processes, mainly followed by urinary processes (21.4%). Mortality in the group using hydrocortisone for less than 12 hours was 14 of the 37 patients (37.8%) and in the group using hydrocortisone for more than 12 hours it was five of the 14 patients selected in this group (35.7%). Without statistical significance for mortality in the comparison of both groups (p = 0.92, CI 95% 0.7-1.3).]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução:  O choque séptico é a complicação mais grave da sepse, com uma alta mortalidade que, em alguns estudos, chega a 50%. O tratamento para pacientes com choque séptico inclui o uso multimodal de cristaloides, vasopressores, antibióticos e esteroides. As evidências sobre o uso de esteroides nessa população permanecem controversas devido à falta de padronização sobre o início desse medicamento no cenário do choque séptico. O início dessa terapia como adjuvante tem sido descrito desde 2016 nas diretrizes da Surviving Sepsis Campaign. Na última atualização sobre sepse, a recomendação sobre o início da hidrocortisona é feita quando, apesar da hidratação e da terapia vasopressora, não é possível restaurar a estabilidade hemodinâmica. A dose ideal, o tempo de início e a duração do uso de esteroides permanecem incertos. Os estudos demonstram que isso ocorre quando uma pressão arterial média superior a 60 mmHg não pode ser mantida por mais de 4 a 6 horas. Isso não condiciona o uso precoce, pois no contexto do choque isso pode ocorrer após as primeiras 24 horas. Portanto, decidiu-se realizar este estudo observacional para determinar a mortalidade em pacientes com uso precoce de esteroides na unidade de terapia intensiva.  Objetivo:  determinar se o uso de hidrocortisona dentro de 12 horas em pacientes com choque séptico diminui a mortalidade hospitalar e em 28 dias.  Material e métodos:  foi realizado um estudo retrospectivo, analítico, retroprojetivo e longitudinal. Coorte histórica. Foram admitidos pacientes com diagnóstico de choque séptico de qualquer etiologia. Eles foram divididos em grupos de acordo com o tempo de início do uso de esteroides. Menos de 12 horas ou mais de 12 horas. Os dados foram coletados do arquivo eletrônico do caso. Os dados coletados foram classificados e descritos em termos de estatística descritiva; as variáveis nominais e ordinais foram descritas por número absoluto e porcentagem; as variáveis numéricas foram descritas, dependendo do tipo de distribuição, com intervalo, média e desvio padrão, ou com intervalo, mediana e percentis, para análise bivariada. Efeito das manobras periféricas sobre o resultado, foi usado o teste &#967;2 ou o teste exato de Fisher e a análise multivariada analisará a associação entre o uso precoce de hidrocortisona (definido como menos de 12 horas) em pacientes com choque séptico, ajustado para variáveis de linha de base, variáveis periféricas; por meio de riscos proporcionais de Cox, com seus HRs e seus respectivos intervalos de confiança de 95% ou, na falta disso, será aplicado o teste de regressão logística.  Resultados:  foram avaliados dados de 70 pacientes com diagnóstico de choque séptico e uso precoce de hidrocortisona, &lt; 12 horas vs &gt; 12 horas, na unidade de terapia intensiva do Centro Médico do ABC durante o período de 1o de março de 2022 a 31 de agosto de 2023. A amostra consistiu em 51.4% (N = 36) e 48.6% de pacientes do sexo masculino (N = 34). A idade mediana foi de 70.41 anos (IQR 62.7, 83.25) com uma variação entre 18 e 84 anos. Com relação à origem do choque séptico, verificou-se que a causa do choque séptico se deveu a processos abdominais (38.6%) e pulmonares (34.6%), seguidos principalmente por processos urinários (21.4%). A mortalidade no grupo que usou hidrocortisona por menos de 12 horas foi de 14 dos 37 pacientes (37.8%) e no grupo que usou hidrocortisona por mais de 12 horas foi de 5 dos 14 pacientes selecionados nesse grupo (35.7%), sem significância estatística para a mortalidade na comparação dos dois grupos (p = 0.92, IC 95% 0.7-1.3).]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[hidrocortisona]]></kwd>
<kwd lng="es"><![CDATA[choque séptico]]></kwd>
<kwd lng="es"><![CDATA[mortalidad]]></kwd>
<kwd lng="es"><![CDATA[estudio observacional retrospectivo retroprolectivo]]></kwd>
<kwd lng="en"><![CDATA[hydrocortisone]]></kwd>
<kwd lng="en"><![CDATA[septic shock]]></kwd>
<kwd lng="en"><![CDATA[mortality]]></kwd>
<kwd lng="en"><![CDATA[retroprolective retrospective observational study]]></kwd>
<kwd lng="pt"><![CDATA[hidrocortisona]]></kwd>
<kwd lng="pt"><![CDATA[choque séptico]]></kwd>
<kwd lng="pt"><![CDATA[mortalidade]]></kwd>
<kwd lng="pt"><![CDATA[estudo observacional retrospectivo retroprojetivo]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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