A 54-year-old patient with a 3-month history of nephrotic syndrome secondary to extramedullary nephropathy (massive proteinuria) treated with conservative treatment with corticosteroids and renal function.
He was admitted to the Intensive Care Unit on December 22, 2006 for septic shock secondary to a necrotizing fasciitis of the right foot.
Upon admission, the patient already presented with MODS, respiratory (acute pulmonary injury), renal, neurological and coagulation impairment, with an APACHE II score of 24.
The initial resuscitation was performed according to the septic shock management protocol of our Unit10 and the recommendations of the Sepsis11 Survivorship Campaign.
She was connected to mechanical ventilation (MV), started with fluids (3,300 ml in the first 6 h between crystalloids and colloids, maintaining PAOP greater than 15 mmHg) and recent vasoactive drugs (hydromycin administered).
The patient was taken to the operating room where a surgical loop was performed with right bundle fasciotomy.
Haemorrhage
During the procedure, the patient had a poor outcome, with an increase in the requirements for vasoconstrictive agents (noradrenaline) and hyperperfusion.
The microdischarge was assessed prior to the onset of HF (at 10 o'clock in ICU admission), at 12 o'clock in connection with HF and at 6 o'clock in silence.
In the first evaluation, the patient presented severe alterations in microstructure, with an MFI of 1.15, progressing later with improvement of these alterations, which was not correlated with the other perfusion parameters.
1.
At 4 days of evolution vasoactive drugs were suspended, and at 10 days, after several surgical interventions, an infracondylar amputation was performed.
Subsequently, the patient recovered his dysfunctions, except for renal failure, requiring dialysis support, but had several infectious complications ( nosocomial pneumonia and sepsis due to central venous catheter).
The patient was discharged from the ICU in early February 2007, being discharged on February 18, 2007.
Currently he is under control in the polycllnic nephrology of our hospital, with triweekly hemodialysis.
