Prevención y manejo clínico de la neumonía asociada a ventilación mecónica en unidad de cuidados intensivos
DOI:
https://doi.org/10.23857/dc.v8i2.2768Palabras clave:
Ventilación mecánica, morbimortalidad, neumonÃa nosocomial, bacterianas.Resumen
La neumonía asociada a ventilación mecónica es una complicación una gran incidencia y morbimortalidad, con unas particulares características que la diferencian de la neumonía nosocomial en pacientes no intubados. Entre las consecuencias, tenemos unas medidas terapéuticas muchas veces exageradas que se ha demostrado soportan el origen de severidades bacterianas. De ahí el interés de realizar el presente artículo sobre la prevención, manejo clínico, el diagnóstico y la estrategia terapéutica de este tipo de neumonía.
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Gallego M, Rello J. Diagnostic testing for ventilator-associated pneumonía. Clin Chest Med, 20 (1999), pp. 671-679
Souweine B, Veber B, Bedos JP, Gachot B, Dombret MC, Regnier B et al. Diagnostic accuracy of protected specimen brush and bronchoalveolar lavage in nosocomial pneumonia: impact of previous antimicrobial treatments. Crit Care Med, 26 (1998), pp. 236-244 Medline
Effect of previous antimicrobial therapy on the accuracy of the main procedures used to diagnose nosocomial pneumonia in patients who are using ventilation. Chest. 1995; 108: 1036-1040.
Chastre J, Viau F, Brun P, Pierre J, Dauge MC, Bouchama A et al.Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infections in ventilated patients. Am Rev Respir Dis, 130 (1984), pp. 924-929
Pham LH, Brun-Buisson C, Legrand P, Rauss A, Verra F, Brochard L et al. Diagnosis of nosocomial pneumonia in mechanically ventilated patients. Comparison of a plugged telescoping catheter with the protected specimen brush. Am Rev Respir Dis, 143 (1991), pp. 1055-1061
Bronchoscopy for ventilator-associated pneumonia: show me the money (outcome benefit)! Crit Care Med 1998; 26: 198-199.
álvarez-Lerma F. Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit. ICU-Acquired Pneumonia Study Group. Intensive Care Med, 22 (1996), pp. 387-394
The influence of mini-BAL cultures on patient outcomes: implications for the antibiotic management of ventilator-associated pneumonia. Chest. 1998; 113: 412-420.
Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia.Chest 1997; 111: 676-685.
Rello J, Gallego M, Mariscal D, Sonora R, Vallí©s J. The value of routine microbial investigation in ventilator-associated pneumonia. Am J Respir Crit Care Med, 156 (1997), pp. 196-200
Sánchez-Nieto JM, Torres A, García-Córdoba F, El-Ebiary M, Carrillo A, Ruiz J et al. Impact of invasive and noninvasive quantitative culture sampling on outcome of ventilator-associated pneumonia: a pilot study. Am J Respir Crit Care Med, 157 (1998), pp. 371-376
Estes RJ, Meduri GU.The pathogenesis of ventilator-associated pneumonia: I. Mechanisms of bacterial transcolonization and airway inoculation. Intensive Care Med, 21 (1995), pp. 365-383
Meduri GU, Estes RJ. The pathogenesis of ventilator-associated pneumonia: II. The lower respiratory tract. Intensive Care Med, 21 (1995), pp. 452-461
Kollef MH. The prevention of ventilator-associated pneumonia. N Engl J Med, 340 (1999), pp. 627-634
Torres A, Serra-Batlles J, Ros E, Piera C, Puig de la Bellacasa J, Cobos A et al.. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med, 116 (1992), pp. 540-543
Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet, 354 (1999), pp. 1851-1858
Torres A, Gatell JM, Aznar E, El-Ebiary M, Puig de la Bellacasa J, González J et al. Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med, 152 (1995), pp. 137-41
Vallí©s J, Artigas A, Rello J, Bonsoms N, Fontanals D, Blanch L et al. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia.. Ann Intern Med, 122 (1995), pp. 179-86
Rello J, Sonora R, Jubert P, Artigas A, Rue M, Vallí©s J. Pneumonia in intubated patients: role of respiratory airway care. Am J Respir Crit Care Med, 154 (1996), pp. 111-115
Nourdine K, Combes P, Carton MJ, Beuret P, Cannamela A, Ducreux JC. Does noninvasive ventilation reduce the ICU nosocomial infection risk? A prospective clinical survey. Intensive Care Med, 25 (1999), pp. 567-573
Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med, 335 (1996), pp. 1864-1869
Kollef MH, Shapiro SD, Clinkscale D, Cracchiolo L, Clayton D, Wilner R et al. The effect of respiratory therapist-initiated treatment protocols on patient outcomes and resource utilization. Chest, 117 (2000), pp. 467-475
Heyland DK. Nutritional support in the critically ill patients. A critical review of the evidence. Crit Care Clin, 14 (1998), pp. 423-440
Tryba M. Sucralfate versus antacids or H2-antagonists for stress ulcer prophylaxis: a meta-analysis on efficacy and pneumonia rate. Crit Care Med, 19 (1991), pp. 942-949
Cook DJ, Laine LA, Guyatt GH, Raffin TA. Nosocomial pneumonia and the role of gastric pH. A meta-analysis. Chest, 100 (1991), pp. 7-13
Cook DJ, Reeve BK, Scholes LC. Histamine-2-receptor antagonists and antacids in the critically ill population: stress ulceration versus nosocomial pneumonia. Infect Control Hosp Epidemiol, 15 (1994), pp. 437-442
Cook D, Guyatt G, Marshall J, Leasa D, Fuller H, Hall R et al. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. N Engl J Med, 338 (1998), pp. 791-797
Trouillet JL, Chastre J, Vuagnat A, Joly-Guillou ML, Combaux D, Dombret MC et al. Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med, 157 (1998), pp. 531-539
Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med, 94 (1993), pp. 281-288
Holzapfel L, Chastang C, Demingeon G, Bohe J, Piralla B, Coupry A. A randomized study assessing the systematic search for maxillary sinusitis in nasotracheally mechanically ventilated patients. Influence of nosocomial maxillary sinusitis on the occurrence of ventilator-associated pneumonia. Am J Respir Crit Care Med, 159 (1999), pp. 695-701
Gastinne H, Wolff M, Delatour F, Faurisson F, Chevret S. A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. The French Study Group on Selective Decontamination of the Digestive Tract. N Engl J Med, 326 (1992), pp. 594-599
DeRiso AJ II, Ladowski JS, Dillon TA, Justice JW, Peterson AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest, 109 (1996), pp. 1556-1561
American Thoracic Society. Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, American Thoracic Society, November 1995. Am J Respir Crit Care Med, 153 (1996), pp. 1711-1725
Torres A, Elebiary M, Rañó A. Respiratory infectious complications in the Intensive care unit. Clin Chest Med, 20 (1999), pp. 287-302
Gallego M, Rello J. Diagnostic testing for ventilator-associated pneumonia. Diagnostic testing for ventilator-associated pneumonia. Clin Chest Med, 20 (1999), pp. 671-679
Rello J, Sa-Borges M, Correa H, Leal SR, Baraibar Jl. Variations in etiology of ventilator-associated pneumonia across four treatment sites: implications for antimicrobial prescribing practices. Am J Respir Crit Care Med, 160 (1999), pp. 608-613
Rello J. Impact of nosocomial infections on outcome: myths and evidence. Infect Control Hosp Epidemiol, 20 (1999), pp. 392-394
Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. Am J Respir Crit Care Med, 162 (2000), pp. 505-511
Gallego M, Valles J, Rello J. New perspectives in the diagnosis of nosocomial pneumonia. Curr Opin Pulm Med, 3 (1997), pp. 116-119
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