Molinar RF, Vázquez HMI, Baltazar TJÁ, Salazar EDC, Cruz ME

Idioma: Español
Referencias bibliográficas: 30
Paginas: 18-21
Archivo PDF: 58.86 Kb.

RESUMEN

Objetivo: Conocer la incidencia de la neumonía asociada al ventilador (NAV) en pacientes críticos. Diseño: Estudio retrospectivo. Lugar: UCI de un hospital de tercer nivel, Ciudad de México. Pacientes: Doscientos noventa y dos pacientes asistidos con ventilación mecánica fueron incluidos. Intervenciones: Ninguna. Resultados: Los más importantes factores de riesgo para el desarrollo de NAV fueron el uso de antibióticos, bloqueadores H², sedantes y esteroides, así como reintubación y diabetes mellitus. La Pseudomona aeruginosa fue el principal germen aislado. La estancia fue 13.5 ± 8.4 días y la mortalidad de 22.58%. Conclusión: Los factores de riesgo más importantes para el desarrollo de NAV fueron el uso de antibióticos, bloqueadores H², sedantes y esteroides.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Rello J, Mariscal D, Gallego M et al. Neumonía nosocomial en UCI: etiologías de la neumonía asociada a la ventilación mecánica. Rev Iberolat C Int 1999; 8(3): 64-70.

2. Timsit JF, Chevret S, Valcke J et al. Mortality of nosocomial pneumonia in ventilated patients: Influence of diagnostic tools. A J Respir Crit Care Med 1996; 154: 116-23.

3. Fagon JY, Chastre J, Hance AJ et al. Nosocomial pneumonia in ventilated patients: A cohort study evaluating attributable mortality and Hospital stay. Am J Med 1993; 94: 281-88.

4. Meduri GU, Reddy RC, Stanley T et al. Pneumonia in acute respiratory distress syndrome. Am J Respir Crit Care Med 1998; 58: 870-75.

5. Thomason M, Robbins P. Nosocomial pneumonia in ventilated trauma patients during stress ulcer prophylaxis with sucralfate, antacid and ranitidine. J Trauma 1996; 41(3): 503-8.

6. Fink JB, Krause SA, Barret L et al. Extending ventilator circuit change interval beyond 2 days reduces the likelihood of ventilator-associated pneumonia. Chest 1998; 113: 405-11.

7. Djedaini K, Billard M, Mier L et al. Changing heat and moisture exchangers every 48 hours rather than 24 hours does not affect their efficacy and incidence of nosocomial pneumonia. Am J Respir Crit Care Med 1995: 1562-9.

8. Rello J, Soñora R, Jubert P et al. Pneumonia in intubated patients: Role of respiratory airway care. Am J Respir Crit Care Med 1996; 154: 111-5.

9. Torres A, Gatell JM, Aznar E et al. Re-intubations increase the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 1995; 152: 137-41.

10. Rello J, Diaz E, Roque M et al. Risk factors for developing pneumonia within 48 hours of intubations. Am J Respir Crit Care Med 1999; 159: 1742-46.

11. Rello J, Ausina V, Ricart M et al. Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia. Chest 1993; 104: 1230-5.

12. Cook DJ, Walter SD, Cook RJ et al. Incidence of and risk factors for ventilator-associated pneumonia in critically III patients. Ann Intern Med 1998; 129: 433-440.

13. Kollef MH, Harz BV, Prentice D et al. Patients transport from intensive care increases the risk of developing ventilator-associated pneumonia. Chest 1997; 112: 765-73.

14. Valles J, Artigas A, Rello J et al. Continuous aspiration of subglotic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 1995; 122: 179-86.

15. Kollef MH. The prevention of ventilator- associated pneumonia. N Engl J Med 1999; 340(8): 627-634.

16. Bonten MJ, Bergmans D, Ambergen AW et al. Risk factors for pneumonia and colonization of respiratory tract and stomach in mechanically ventilated UCI patients. Ann J Respir Crit Care Med 1996; 154: 1339-46.

17. Timset J, Misset B. Effect of previous antimicrobial on the accuracy of main procedures used to diagnose nosocomial pneumonia in patients who are using ventilation. Chest 1995; 108(4): 1036-40.

18. Fagon JY, Chastre J, Domart Y et al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 1989; 139: 877-84.

19. Chastre J, Fagon J, Bornet-Lecso M et al. Evaluation of bronchoscopic techniques for the diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med 1995; 15: 231-40.

20. Levine SA, Niederman MS. The impact of tracheal intubations on host defenses and risk for nosocomial pneumonia. Clin Chest Med 1991; 12: 523-43.

21. Gross P. Epidemiology of hospital-acquired pneumonia. Semin Respir Infect 1987; 2: 2-7.

22. Rello J. Pulmonary embolism due to and indwelling central venous catheter. Chest 1991; 100: 1477-8.

23. El-Ebiary M, Torres A, Fabregas N et al. Significance of the isolation of candida species from respiratory samples in critically ill, non-neutropenic patients. Am J Respir Crit Care Med 1997; 156: 583-90.

24. Mertns AH, Nagler JM, Galdermans DI et al. Diagnosis value of direct examination of protected specimen brush samples in nosocomial pneumonia. Eur J Clin Microbiol Infect Dis 1996; 15(10): 807-10.

25. Barlabar J, Correa H. Risk factors for infection by Acinetobacter baumannii in intubated patients with nosocomial pneumonia. Chest 1997; 112(4): 1050-4.

26. Hellings TS, Van WC, Krantz S et al. The value clinical judgment in the diagnosis of nosocomial pneumonia. Am J Surg 1996; 17(6): 570-575.

27. Gerbeaux P, Ledoray V, Boussuges A et al. Diagnosis of nosocomial pneumonia in mechanically ventilated patients. Am J Respir Crit Care Med 1998; 157: 76-80.

28. Mayhall CG. Nosocomial pneumonia: diagnosis and prevention. Infectious disease clinics of North America 1997; 11(2): 427-57.

29. Alvarez-Lerma F. Modification of empiric antibiotic treatment in patients with pneumonia acquired in intensive Care Unit. Intensive Care Med 1996; 22: 387-94.

30. Kollef M, Vlanisk J, Sharpless L et al. Scheduled change of antibiotic classes: a strategy to decrease the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med 1997; 156: 1040-48.