Nursing care and epidemiological profile of patients with ventilator-associated pneumonia / Cuidados de enfermagem e perfil epidemiológico de pacientes com pneumonia associada à ventilação mecânica / Cuidados de enfermería y perfil epidemiológico de pacientes con neumonía asociada a ventilador

Background and Objectives: to assess the epidemiological profile of patients diagnosed with ventilator-associated pneumonia (VAP) in an Intensive Care Unit (ICU) and to investigate nursing care adequacy. Methods: a quantitative retrospective cohort study, applied in the ICU of a hospital in the countryside of Rio Grande do Sul. It involved 100% of medical records of patients over 20 years of age, in the year 2019, who developed VAP. Results: a total of 3,215 patients were on invasive mechanical ventilation (IMV), and of these 13 developed VAP (2.47%). Most were men (76.92%), with a mean age of 60.3 years, whose main causes of hospitalization were heart problems (30.77%), multiple trauma (30.77%) and stroke (15.39%). The main pathogens found in tracheal aspirates were Acinetobacter sp. (15%) and Pseudomonas aeruginosa (15%). The mean ICU stay was 30.61 days, and 61.53% died. For nursing care assessment, the mean checklist of the VAP bundle applied was calculated, according to the number of days in VMI. The result was 2.62 checklists per day, with the institution recommending four. Conclusion: the study made it possible to know the epidemiological profile of patients with VAP, in addition to observing the need for improvement in nursing care, considering that the checklist completion was below the recommended.(AU)

Justificativa e Objetivos: avaliar o perfil epidemiológico de pacientes diagnosticados com pneumonia associada à ventilação mecânica (PAVM) em Unidade de Terapia Intensiva (UTI) e investigar a adequação dos cuidados de enfermagem. Métodos: estudo quantitativo de coorte, retrospectivo, aplicado na UTI de um hospital do interior do Rio Grande do Sul. Envolveu 100% dos prontuários de pacientes com mais de 20 anos de idade, no ano de 2019, que desenvolveram PAVM. Resultados: estiveram em ventilação mecânica invasiva (VMI) 3.215 pacientes e, desses, 13 desenvolveram PAVM (2,47%). A maioria era homens (76,92%), com média de idade de 60,3 anos, cujas principais causas de internação foram problemas cardíacos (30,77%), politraumatismo (30,77%) e acidente vascular cerebral (15,39%). Os principais patógenos encontrados nos aspirados traqueais foram Acinetobacter sp (15%) e Pseudomonas aeruginosa (15%). A média de permanência na UTI foi de 30,61 dias, e foram a óbito 61,53%. Para avaliação dos cuidados de enfermagem, foi calculada a média de checklist do bundle de PAVM, aplicados, conforme a quantidade de dias em VMI. O resultado foi de 2,62 checklists por dia, sendo que a instituição preconiza quatro. Conclusão: o estudo permitiu conhecer o perfil epidemiológico dos pacientes com PAVM, além de observar a necessidade de melhora nos cuidados de enfermagem, considerando que a realização do checklist ficou abaixo do recomendado.(AU)

Justificación y Objetivos: evaluar el perfil epidemiológico de pacientes con diagnóstico de neumonía asociada a ventilación mecánica (NAVM) en una Unidad de Cuidados Intensivos (UCI) e investigar la adecuación de los cuidados de enfermería. Métodos: estudio de cohorte cuantitativo, retrospectivo, aplicado en el UCI de un hospital del interior de Rio Grande do Sul. Involucró el 100% de las historias clínicas de pacientes mayores de 20 años, en el año 2019, que desarrollaron NAVM. Resultados: un total de 3.215 pacientes estaban en ventilación mecánica invasiva (VMI), y, de estos, 13 desarrollaron NAVM (2,47%). La mayoría eran hombres (76,92%), con una edad media de 60,3 años, cuyas principales causas de hospitalización fueron problemas cardíacos (30,77%), politraumatismos (30,77%) y accidentes cerebrovasculares (15,39%). Los principales patógenos encontrados en los aspirados traqueales fueron Acinetobacter sp (15%) y Pseudomonas aeruginosa (15%). La estancia media en UCI fue de 30,61 días, y falleció el 61,53%. Para la evaluación de la atención de enfermería, se calculó el checklist promedio del bundle VAP aplicado, de acuerdo con el número de días en VMI. El resultado fue de 2,62 checklists por día, y la institución recomendó cuatro. Conclusión: el estudio posibilitó conocer el perfil epidemiológico de los pacientes con NAVM, además de observar la necesidad de mejoría en la atención de enfermería, considerando que el llenado del checklist estuvo por debajo de lo recomendado.(AU)

Neumonía asociada a ventilación mecánica en pacientes con neumonía grave por SARS-CoV-2 / Ventilation associated pneumonia in patients with severe SARS-CoV-2 pneumonia

Introducción: Los pacientes con COVID-19 pueden evolucionar hacia una falla respiratoria aguda grave y requerir ventilación mecánica invasiva (VMI). La complicación más frecuente en estos pacientes es la neumonía asociada a ventilación mecánica (NAVM), con incidencias reportadas más altas que en la época pre-COVID. El objetivo de este estudio es reportar la incidencia, tasa de incidencia y microbiología de la NAVM en pacientes en VMI con COVID-19. Métodos: Se incluyeron a todos los pacientes con neumonía grave y PCR (+) para SARS-CoV-2 que ingresaron y requirieron VMI entre marzo y julio del 2021 en el Instituto Nacional del Tórax (INT). Se recolectaron datos demográficos, clínicos y de laboratorio de la ficha electrónica. Se registraron y caracterizaron los casos de neumonía asociado a la ventilación mecánica. Resultados: Se incluyeron 112 pacientes de los cuales el 42,8% presentó NAVM, con una tasa de incidencia de 28,8/1.000 días de VMI. Los microorganismos aislados más frecuentes fueron Klebsiella pneumoniae (29,6%), Staphylococcus aureus (21,8%) y Pseudomonas aeruginosa (12,5%). Los pacientes que cursaron NAVM estuvieron casi el doble de tiempo en VMI, pero sin presentar aumento de la mortalidad. Conclusión: La NAVM es una complicación frecuente en los pacientes con neumonía grave asociada a COVID-19. La microbiología de estas entidades no ha cambiado respecto a la era pre-pandémica. Estos resultados cobran relevancia en el inicio y suspensión de antibióticos en este grupo de pacientes.

Introduction: Patients with COVID-19 can progress to severe acute respiratory failure and require invasive mechanical ventilation (IMV). The most frequent complication in these patients is ventilator-associated pneumonia (VAP), with higher reported incidences than in the pre-COVID era. The objective of this study is to report the prevalence, incidence rate and microbiology of VAP in patients on IMV with COVID-19. Methods: Patients with severe pneumonia and PCR (+) for SARS-CoV-2 who were admitted to IMV between march and july 2021 at the Instituto Nacional del Tórax (Chile) were included. Demographic, clinical and laboratory data from electronic records were collected. Cases of pneumonia associated with mechanical ventilation were recorded and characterized. Results: 112 patients were included, 42.8% of them presented VAP with an incidence rate of 28.8/1,000 IMV days. The most frequent isolated microorganisms were Klebsiella pneumoniae (29.6%), Staphylococcus aureus (21.8%) and Pseudomonas aeruginosa (12.5%). Patients who underwent VAP spent almost twice as long on IMV, although they had not increase in mortality. Conclusion: VAP is a common complication in patients with severe pneumonia associated with COVID-19. The microbiology of these entities has not changed from the pre-pandemic era. These results become relevant in the initiation and suspension of antibiotics in this group of patients.

Ventilator-associated pneumonia: incidence, microbial etiology and antimicrobial resistance profile / Pneumonia associada à ventilação mecânica: incidência, etiologia microbiana e perfil de resistência antimicrobiana / Neumonía asociada a ventilador: incidencia, etiología microbiana y perfil de resistencia antimicrobiana

Background and Objectives: Infections caused by multi-drug resistant microorganisms have a great clinical and economic impact. The present study proposed to determine and assess ventilator-associated pneumonia (VAP) incidence in an Intensive Care Unit (ICU), to establish the profile of hospitalized patients and to determine the frequency of microorganisms isolated as well as their antimicrobial resistance profile. Methods: A descriptive, documental study, with a quantitative approach, carried out at a teaching hospital. Participants were all individuals admitted to the General ICU who developed VAP in 2018 and 2019. Results: During the study, 146 patients were diagnosed with VAP, with an incidence of 23.66/1000 patient-days on mechanical ventilation. The median age of patients was 52.5 years and most of them were man. One hundred and eight microorganisms were isolated in cultures, the majority being gram-negative bacteria. Non-fermenting bacteria were the most frequent (n=46; 42.6%), followed by enterobacteria (n=42; 38.9%). Staphylococcus aureus was the most frequent microorganism among gram-positive (n=17; 15.7%). The most frequent multi-drug resistant bacteria were Acinetobacter baumannii and Enterobacter spp. No microorganism showed colistin and vancomycin resistance. Patients infected with multi-drug resistant bacteria were hospitalized longer when compared to other patients. Conclusions: VAP incidence was high. The knowledge of the etiologic agents of VAP and their antimicrobial resistance profile is fundamental to support the elaboration of institutional treatment protocols as well as assist in empirical antibiotic therapy.(AU)

Justificativa e Objetivos: As infecções causadas por microrganismos multirresistentes têm grande impacto clínico e econômico. O presente estudo propôs determinar e avaliar a incidência de pneumonia associada à ventilação mecânica (PAV) em uma Unidade de Terapia Intensiva (UTI), estabelecer o perfil dos pacientes internados e determinar a frequência de microrganismos isolados, bem como seu perfil de resistência antimicrobiana. Métodos: Estudo descritivo, documental, com abordagem quantitativa, realizado em um hospital universitário. Participaram todos os indivíduos admitidos na UTI Geral que desenvolveram PAV em 2018 e 2019. Resultados: Durante o estudo, 146 pacientes foram diagnosticados com PAV, com incidência de 23,66/1000 pacientes-dia em ventilação mecânica. A idade mediana dos pacientes foi de 52,5 anos e a maioria era do sexo masculino. Cento e oito microrganismos foram isolados em culturas, sendo a maioria bactérias gram-negativas. As bactérias não fermentadoras foram as mais frequentes (n=46; 42,6%), seguidas das enterobactérias (n=42; 38,9%). Staphylococcus aureus foi o microrganismo mais frequente entre os Gram-positivos (n=17; 15,7%). As bactérias multirresistentes mais frequentes foram Acinetobacter baumannii e Enterobacter spp. Nenhum microrganismo apresentou resistência à colistina e vancomicina. Pacientes infectados com bactérias multirresistentes ficaram mais tempo internados quando comparados a outros pacientes. Conclusões: A incidência de PAV foi alta. O conhecimento dos agentes etiológicos da PAV e seu perfil de resistência antimicrobiana é fundamental para subsidiar a elaboração de protocolos institucionais de tratamento, bem como auxiliar na antibioticoterapia empírica.(AU)

Justificación y Objetivos: Las infecciones causadas por microorganismos multirresistentes tienen un gran impacto clínico y económico. El presente estudio se propuso determinar y evaluar la incidencia de neumonía asociada a ventilación mecánica (NAV) en una Unidad de Cuidados Intensivos (UCI), establecer el perfil de pacientes hospitalizados y determinar la frecuencia de microorganismos aislados así como su perfil de resistencia antimicrobiana. Métodos: Estudio descriptivo, documental, con abordaje cuantitativo, realizado en un hospital escuela. Participaron todas las personas ingresadas en UCI General que desarrollaron NAV en 2018 y 2019. Resultados: Durante el estudio, 146 pacientes fueron diagnosticados con NAV, con una incidencia de 23,66/1000 pacientes-día en ventilación mecánica. La mediana de edad de los pacientes fue de 52,5 años y la mayoría eran hombres. Se aislaron 108 microorganismos en cultivos, siendo la mayoría bacterias gramnegativas. Las bacterias no fermentadoras fueron las más frecuentes (n=46; 42,6%), seguidas de las enterobacterias (n=42; 38,9%). Staphylococcus aureus fue el microorganismo más frecuente entre los grampositivos (n=17; 15,7%). Las bacterias multirresistentes más frecuentes fueron Acinetobacter baumannii y Enterobacter spp. Ningún microorganismo mostró resistencia a colistina y vancomicina. Los pacientes infectados con bacterias multirresistentes fueron hospitalizados por más tiempo en comparación con otros pacientes. Conclusiones: La incidencia de NAV fue alta. El conocimiento de los agentes etiológicos de la VAP y su perfil de resistencia a los antimicrobianos es fundamental para apoyar la elaboración de protocolos de tratamiento institucionales, así como para ayudar en la terapia antibiótica empírica.(AU)

Neumonía asociada a la ventilación mecánica en niños y adolescentes / Pneumonia associated with the mechanical ventilation in children and adolescents

Introducción: La neumonía asociada a la ventilación mecánica es una infección, que se relaciona con los cuidados sanitarios. Objetivo: Caracterizar clínica y epidemiológicamente a niños y adolescentes con neumonía asociada a la ventilación mecánica, según variables seleccionadas. Método: Se realizó un estudio descriptivo y transversal de 36 pacientes con neumonía asociada a la ventilación mecánica, ingresados en la Unidad de Cuidados Intensivos del Hospital Infantil Norte Dr. Juan de la Cruz Martínez Maceira de Santiago de Cuba, desde enero del 2017 hasta diciembre del 2018. Resultados: Se halló un predominio de los pacientes menores de 5 años de edad (80,6 %), del sexo masculino (66,7 %), la ventilación mecánica prolongada (69,4 %) y las neumonías asociadas a la ventilación de aparición tardía relacionadas con la mortalidad. Los microorganismos más frecuentes resultaron ser los gramnegativos. La combinación de cefalosporinas y vancomicina fue la más utilizada. Conclusiones: La evolución de los pacientes dependió del tiempo de inicio, el microorganismo predominante y el tratamiento antimicrobiano empleado.

Introduction: The pneumonia associated with the mechanical ventilation is an infection that is related to the sanitary cares. Objective: To characterize clinical and epidemiologically children and adolescents with pneumonia associated with the mechanical ventilation, according to selected variables. Method: A descriptive and cross-sectional study of 36 patients with pneumonia associated with mechanical ventilation admitted in the Intensive Cares Unit of Dr. Juan de la Cruz Martínez Maceira Northern Children Hospital; was carried out in Santiago de Cuba, from January, 2017 to December, 2018. Results: There was a prevalence of the patients under 5 years (80.6 %), the male sex (66.7 %), the long lasting mechanical ventilation (69.4 %) and pneumonias associated with the ventilation of late appearance related to mortality. The most frequent microorganisms were the Gram negative. The combination of cephalosporins and vancomycin were the most used. Conclusions: The clinical course of the patients depended on the time of beginning, the predominant microorganism and the antimicrobial treatment used.

Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units

Abstract Background Infection control interventions can be erroneously interpreted if outcomes are assessed in short periods. Also, statistical methods usually applied to compare outcomes before and after interventions are not appropriate for analyzing time series. Aims To analyze the impact of a bundle directed at reducing the incidence of ventilator-associated pneumonia (VAP) and other device-associated infections in two medical-surgical intensive care units (ICU) in Brazil. Methods Our study had a quasi-experimental design. Interrupted time series analyses (ITS) was performed assessing monthly rates of overall healthcare-associated infections (HCAI), VAP, laboratory-confirmed central line associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI), from January 2007 through June 2019. Moreover, multivariate ITS was adjusted for seasonality in Poisson regression models. An intervention based on a bundle for VAP prevention was introduced in August 2010. Findings The intervention was followed by sustained reduction in overall HCAI, VAP and CLABSI in both ICU. Continuous post-intervention trends towards reduction were detected for overall HCAI and VAP. Conclusion Interventions aimed at preventing one specific site of infection may have sustained impact on other HCAI, which can be documented using time series analyses.

Resultados de la asincronía ventilatoria en pacientes con esfuerzo inspiratório / Outcomes of ventilatory asynchrony in patients with inspiratory effort

RESUMO Objetivo: Identificar la relación de la asincronía paciente-ventilador con el nivel de sedación y evaluar la asociación con los resultados hemogasométricos y clínicos. Métodos: Estudio prospectivo de 122 pacientes admitidos en la unidad de cuidados intensivos con > 24 horas de ventilación mecánica invasiva y esfuerzo inspiratorio. En los primeros 7 días de ventilación, diariamente se evaluó la asincronía paciente-ventilador durante 30 minutos. La asincronía paciente-ventilador severa se definió con un índice de asincronía > 10%. Resultados: Se evaluaron 339.652 ciclos respiratorios en 504 observaciones. La media del índice de asincronía fue 37,8% (desviación estándar 14,1% - 61,5%). La prevalencia de asincronía paciente-ventilador severa fue 46,6%. Las asincronías paciente-ventilador más frecuentes fueron: trigger ineficaz (13,3%), auto-trigger (15,3%), flujo insuficiente (13,5%) y ciclado demorado (13,7%). La asincronía paciente-ventilador severa se relacionó con el nivel de sedación (trigger ineficaz: p = 0,020; flujo insuficiente: p = 0,016; ciclado precoz: p = 0,023) y el uso de midazolam (p = 0,020). La asincronía paciente-ventilador severa se asoció con las alteraciones hemogasométricas. La persistencia de la asincronía paciente-ventilador severa fue un factor de riesgo independiente para fracaso en la prueba de ventilación espontánea, tiempo de ventilación, neumonía asociada al ventilador, disfunción de órganos, mortalidad en la unidad de cuidados intensivos y estadía en la unidad de cuidados intensivos. Conclusión: La asincronía paciente-ventilador es un trastorno frecuente en los pacientes críticos con esfuerzo inspiratorio. La interacción del paciente con el ventilador debe optimizarse para mejorar los parámetros hemogasométricos y los resultados clínicos. Se requieren otros estudios que confirmen estos resultados.

Abstract Objective: To identify the relationship of patient-ventilator asynchrony with the level of sedation and hemogasometric and clinical results. Methods: This was a prospective study of 122 patients admitted to the intensive care unit who underwent > 24 hours of invasive mechanical ventilation with inspiratory effort. In the first 7 days of ventilation, patient-ventilator asynchrony was evaluated daily for 30 minutes. Severe patient-ventilator asynchrony was defined as an asynchrony index > 10%. Results: A total of 339,652 respiratory cycles were evaluated in 504 observations. The mean asynchrony index was 37.8% (standard deviation 14.1 - 61.5%). The prevalence of severe patient-ventilator asynchrony was 46.6%. The most frequent patient-ventilator asynchronies were ineffective trigger (13.3%), autotrigger (15.3%), insufficient flow (13.5%), and delayed cycling (13.7%). Severe patient-ventilator asynchrony was related to the level of sedation (ineffective trigger: p = 0.020; insufficient flow: p = 0.016; premature cycling: p = 0.023) and the use of midazolam (p = 0.020). Severe patient-ventilator asynchrony was also associated with hemogasometric changes. The persistence of severe patient-ventilator asynchrony was an independent risk factor for failure of the spontaneous breathing test, ventilation time, ventilator-associated pneumonia, organ dysfunction, mortality in the intensive care unit, and length of stay in the intensive care unit. Conclusion: Patient-ventilator asynchrony is a frequent disorder in critically ill patients with inspiratory effort. The patient's interaction with the ventilator should be optimized to improve hemogasometric parameters and clinical results. Further studies are required to confirm these results.

Traqueobronquite associada à ventilação mecânica: uma atualização / Ventilator-associated tracheobronchitis: an update

RESUMO As infecções do trato respiratório inferior associadas à ventilação mecânica são uma das complicações mais frequentes em pacientes em ventilação mecânica. Há muitos anos, a traqueobronquite associada à ventilação mecânica tem sido considerada uma doença que não demanda antibioticoterapia. Na última década, diversos estudos demonstraram que a traqueobronquite associada à ventilação mecânica deve ser considerada um processo intermediário que leva à pneumonia associada à ventilação mecânica, uma vez que apesar de ter impacto limitado sobre a mortalidade dos pacientes gravemente enfermos internados nas unidades de terapia intensiva, em contrapartida, demonstra associação significativa com o aumento dos custos hospitalares desses pacientes, assim como do tempo de internação na unidade de terapia intensiva e hospitalar, do uso de antibióticos, e da duração da ventilação mecânica. Embora ainda necessitemos de evidências científicas mais robustas, especialmente no que tange às modalidades terapêuticas, os dados atuais a respeito da traqueobronquite associada à ventilação mecânica salientam que há desfechos suficientemente importantes que exigem vigilância epidemiológica e controle clínico adequados.

ABSTRACT Ventilator-associated lower respiratory tract infection is one of the most frequent complications in mechanically ventilated patients. Ventilator-associated tracheobronchitis has been considered a disease that does not warrant antibiotic treatment by the medical community for many years. In the last decade, several studies have shown that tracheobronchitis could be considered an intermediate process that leads to ventilator-associated pneumonia. Furthermore, ventilator-associated tracheobronchitis has a limited impact on overall mortality but shows a significant association with increased patient costs, length of stay, antibiotic use, and duration of mechanical ventilation. Although we still need clear evidence, especially concerning treatment modalities, the present study on ventilator-associated tracheobronchitis highlights that there are important impacts of including this condition in clinical management and epidemiological and infection surveillance.

Ventilator-associated pneumonia agents in Brazilian Neonatal Intensive Care Units - a systematic review

ABSTRACT Introduction Ventilator-associated pneumonia (VAP) is one of the most common healthcare-associated infections (HAI) in neonates admitted in neonatal intensive care units (NICUs). Methods We did a systematic review using PRISMA methodology to identify the main etiological agents in Brazilian NICUs. Eligible studies published without period restriction were identified in PUBMED, SCIELO, LILACS and DOAJ. Studies were included if they were conducted in neonates hospitalized at NICU. Studies done in outpatient care, neonates outside NICU, emergency department, primary care, long-term care facilities or a combination of these were excluded. Results We identified 6384 articles in the initial search and four papers met the inclusion criteria. In all studies included, rates of device-associated infections were described, including VAP rates. The VAP incidence density, in exclusively Brazilian NICU, ranged from 3.2 to 9.2 per 1000 ventilator-days. Pneumonia was described as the main HAI in NICU in one article, as the second type of HAI in two other articles and as the fourth type of HAI in the last one. The main pathogens causing all HAI types were described in three of four articles, but, none of the articles reported which pathogens were related or associated to VAP. Conclusion Etiological agents causing VAP in Brazilian NICUs are, until the present time, not known.

Characterization of post-surgical critical patients with infections associated with healthcare after prolonged perfusion of remifentanil

SUMMARY INTRODUCTION Healthcare associated infections (HAI) are the most frequent complication of hospitalized patients. The aim of this study was to describe the clinical and epidemiological characteristics of critically ill post-surgical patients with a diagnosis of healthcare associated infections, after a pattern of sedoanalgesia of at least 4 days. METHODS All patients over 18 years of age with a unit admission of more than 4 days were consecutively selected. The study population was the one affected by surgical pathology where sedation was based as analgesic the opioid remifentanil for at least 96 hours in continuous perfusion. Patients who died during admission to the unit and those with combined analgesia (peripheral or neuroaxial blocks) were excluded. Data analysis was performed using the statistical package Stata version 7.0. RESULTS The patients admitted to the Post-Surgical Critical Care Unit (PCU) during study were 1789 and the population eligible was comprised of 102 patients. 56.86% of patients suffered IACS. The most frequent IACS was pneumonia associated with mechanical ventilation (30.96 per 1000 days of mechanical ventilation), Pseudomonas aeruginosa being the most frequently isolated germ. The germs with the greatest involvement in multiple drug resistance (MDROs) were enterobacteria, mainly Klebsiella pneumoniae resistant to extended-spectrum beta-lactamases (ESBL). CONCLUSIONS Pneumonia associated with mechanical ventilation is the most prevalent HAI and Pseudomonas aeruginosa is the main etiological agent. The groups of antibiotics most frequently used were cephalosporin and aminoglycosides. It is necessary to implement the prevention strategies of the different HAI, since most of them are avoidable.

RESUMO INTRODUCCIÓN Las infecciones asociadas a cuidados de salud (IACS) constituyen la complicación más frecuente de los pacientes hospitalizados. El objetivo de este estudio es describir las características clínicas y epidemiológicas de los pacientes críticos postquirúrgicos con diagnóstico de infección asociada a cuidados de salud, tras una pauta de sedoanalegia de al menos 4 días. MÉTODOS Se seleccionaron de manera consecutiva todos los pacientes mayores de 18 años con un ingreso en la Unidad de Reanimación Postquirúrgica (URP) superior a 4 días. La población de estudio fue aquella afectada por patología quirúrgica de cualquier origen donde la sedación se basó en cualquier hipnótico y como analgésico el opioide remifentanilo durante al menos 96 horas en perfusión continua. Se excluyeron los pacientes que fallecieron durante su ingreso en la unidad y aquellos pacientes con analgesia combinada (bloqueos periféricos o neuroaxiales). El análisis de los datos se realizó con paquete estadístico Stata versión 7.0. RESULTADOS El número de pacientes que ingresaron en la URP durante el periodo de estudio fueron de 1789. Tras aplicar los criterios de inclusión y exclusión, la población elegible quedó constituida por 102 pacientes. Un 56,86% de pacientes padecieron IACS. La IACS más frecuente fue la neumonía asociada a ventilación mecánica (30,96 por 1000 días de ventilación mecánica) siendo Pseudomona aeruginosa el germen más frecuentemente aislado. Los gérmenes con mayor implicación en las multirresistencias (MDROs) fueron las enterobacterias, principalmente Klebsiella pneumoniae resistente a betalactamasas de espectro extendido (BLEE). CONCLUSIONES La neumonía asociada a ventilación mecánica es la IACS más prevalente y Pseudomona aeruginosa es el principal agente etiológico. Los grupos de antibióticos más frecuentemente empleados fueron cefalosporinas y aminoglucósidos. Es necesario implementar las estrategias de prevención de las distintas IACS, ya que la mayoría de ellas son evitables.

As-needed endotracheal suctioning protocol vs a routine endotracheal suctioning in Pediatric Intensive Care Unit: A randomized controlled trial / Protocolo de aspiración endotraqueal según necesidad vs aspiración endotraqueal de rutina en una Unidad de Cuidado Intensivo Pediátrico: Un ensayo clínico controlado

Abstract Objective: To compare two endotracheal suctioning protocols according to morbidity, days of mechanical ventilation, length of stay in the Pediatric Intensive Care Unit (PICU), incidence of Ventilator-Associated Pneumonia (VAP) and mortality. Methods: A Pragmatic randomized controlled trial performed at University Hospital Pablo Tobón Uribe, Medellin-Colombia. Forty-five children underwent an as-needed endotracheal suctioning protocol and forty five underwent a routine endotracheal suctioning protocol. Composite primary end point was the presence of hypoxemia, arrhythmias, accidental extubation and heart arrest. A logistic function trough generalized estimating equations (GEE) were used to calculate the Relative Risk for the main outcome. Results: Characteristics of patients were similar between groups. The composite primary end point was found in 22 (47%) of intervention group and 25 (55%) children of control group (RR= 0.84; 95% CI: 0.56-1.25), as well in 35 (5.8%) of 606 endotracheal suctioning performed to intervention group and 48 (7.4%) of 649 performed to control group (OR= 0.80; 95% CI: 0.5-1.3). Conclusions: There were no differences between an as-needed and a routine endotracheal suctioning protocol. Trial registration: ClinicalTrials.gov identifier NCT01069185

Resumen Objetivo: Comparar dos protocolos de aspiración endotraqueal con respecto a morbilidad, días de ventilación mecánica, duración de la estancia en la Unidad de Cuidados Intensivos Pediátrica (UCIP), incidencia de neumonía asociada al ventilador (NAV) y mortalidad. Métodos: Ensayo clínico controlado pragmático realizado en el Hospital Universitario Pablo Tobón Uribe, Medellín-Colombia. Cuarenta y cinco niños tratados con un protocolo de aspiración endotraqueal a necesidad y 45 con un protocolo de aspiración endotraqueal rutinaria. El desenlace primario compuesto fue la presencia de hipoxemia, arritmias, extubación accidental y paro cardiorrespiratorio. Se utilizó un modelo de ecuaciones estimables generalizadas (GEE) para calcular el riesgo relativo para el desenlace principal. Resultados: Las características basales fueron similares entre los grupos. El desenlace primario compuesto estuvo presente en 22 (47%) niños del grupo de intervención y 25 (55%) niños del grupo control (RR= 0.84; IC 95%: 0.56-1.25), así como en 35 (5.8%) de las 606 aspiraciones endotraqueales realizadas al grupo de intervención y en 48 (7.4%) de las 649 realizadas al grupo control, (OR= 0.80; IC 95%: 0.5-1.3). Conclusiones: No existen diferencias entre un protocolo de aspiración endotraqueal y uno a necesidad. Registro del ensayo clinico: ClinicalTrials.gov identifier NCT01069185

Comportamiento de neumonía asociada a ventilación mecánica en cuidados intensivos de adultos / Comportamento de pneumonia associado à ventilação mecãnica em terapia intensiva de adultos / Behavior of mechanic ventilator-associated pneumonia in adult at intensive care

Introducción: las neumonías asociadas a la ventilación causan grandes inquietudes a los médicos que plantean serias dificultades diagnósticas las que a su vez motivan a menudo la toma de decisiones terapéuticas desproporcionadas que favorecen la génesis de la resistencia antimicrobiana. Objetivo: valorar el comportamiento de la neumonía asociada a la ventilación mecánica como indicador de calidad asistencial en la Unidad de Terapia Intensiva de Adultos del Hospital General Docente Octavio de la Concepción y de la Pedraja de Baracoa entre enero-diciembre de 2015. Método: se realizó un estudio descriptivo transversal. De un universo de 67 pacientes se tomó una muestra de 27 pacientes por el método aleatorio simple, que desarrollaron esta enfermedad asociada a la ventilación según grupos de edades, sexo, afecciones que propiciaron usarla, tiempo de aparición de los síntomas y resultados microbiológicos. Resultados: las enfermedades de base que más incidieron fueron las enfermedades cerebrovasculares seguidas por distrés respiratorio y sepsis severa. En los primeros nueve días fue que aparecieron los síntomas. Se obtuvo mayor aislamiento de gérmenes Gram negativo. Conclusiones: el comportamiento de las neumonías asociadas a la ventilación estuvo dado en el sexo masculino, mayores de 60 años, se asociaron con mayor frecuencia a las enfermedades cerebrovasculares, en su mayoría los síntomas aparecieron entre 4 y 6 días; el Staphylococcus epidermidis y la Klebsiellap neumoniae fueron los gérmenes que con mayor frecuencia se aislaron en estos pacientes(AU)

Introduction: pneumonias associated with ventilation cause great concern to physicians who pose serious diagnostic difficulties which in turn often motivate the making of disproportionate therapeutic decisions that favor the genesis of antimicrobial resistance. Objective: assess the behavior of pneumonia associated with mechanical ventilation as an indicator of quality of care in the Unit of Intensive Adult Therapy of the General Teaching Hospital "Octavio de la Concepción y de la Pedraja" of Baracoa between January-December 2015. Method: a cross-sectional descriptive study was carried out. From a universe of 67 patients, a sample of 27 patients was taken by the simple random method, which developed this disease associated with ventilation according to age groups, sex, conditions that led to its use, time of onset of symptoms and microbiological results. Results: the underlying diseases that most affected were cerebrovascular diseases followed by respiratory distress and severe sepsis. In the first nine days, the symptoms appeared. Greater isolation of Gram negative germs was obtained. Conclusions: the behavior of the pneumonias associated to ventilation was given in the male sex, older than 60 years, they were associated with a greater frequency to the cerebrovascular diseases, in the majority the symptoms appeared between 4 and 6 days; Staphylococcus epidermidis and Klebsiellap pneumoniae were the germs that were most frequently isolated in these patients(AU)

Introdução: as pneumonias associadas à ventilação são motivo de grande preocupação para os médicos que apresentam sérias dificuldades diagnósticas, que por sua vez, muitas vezes motivam a tomada de decisões terapêuticas desproporcionais que favorecem a gênese da resistência antimicrobiana. Objetivo: avaliar o comportamento da pneumonia associada à ventilação mecânica como um indicador de qualidade de atendimento na Unidade de Terapia Intensiva de Adultos do Hospital Geral de Ensino "Octavio de la Concepción y de la Pedraja" de Baracoa entre janeiro-dezembro de 2015. Método: foi realizado um estudo descritivo transversal. De um universo de 67 pacientes, uma amostra de 27 pacientes foi tomada pelo método aleatório simples, que desenvolveu essa doença associada à ventilação de acordo com as faixas etárias, sexo, condições que levaram ao seu uso, tempo de início dos sintomas e resultados microbiológicos. Resultados: as doenças de base que mais afetaram foram as doenças cerebrovasculares, seguidas de desconforto respiratório e sepse grave. Nos primeiros nove dias, os sintomas apareceram. Maior isolamento de germes Gram negativos foi obtido. Conclusões: o comportamento das pneumonias associadas à ventilação foi dado no sexo masculino, com idade superior a 60 anos, foram associadas com maior frequência às doenças cerebrovasculares, na maioria os sintomas apareceram entre 4 e 6 dias; Staphylococcus epidermidis e Klebsiellap pneumoniae foram os germes mais freqüentemente isolados nesses pacientes(AU)

Impactos e fatores determinantes no bundle de pneumonia associada à ventilação mecânica / Impactos y factores determinantes en cumplimiento del bundle de neumonía asociada a la ventilación mecánica / Determining impacts and factors in ventilator-associated pneumonia bundle

RESUMO Objetivo: avaliar os impactos e fatores determinantes no cumprimento do bundle para redução da pneumonia associada à ventilação mecânica. Método: estudo longitudinal retrospectivo, descritivo, com abordagem quantitativa, realizado no Hospital público de ensino. Coleta realizada entre maio de 2014 e abril de 2015. Participaram da pesquisa, os pacientes da UTI, notificados com PAV. Para a organização dos dados foi utilizado o programa Microsoft Excel 2010. Estabeleceu-se uma análise crítica entre os dados levantados e as taxas de infecção. A pesquisa obteve parecer favorável, sob o n° 566.136. Resultados: observou-se aumento na incidência de PAV após implementação do bundle; os patógenos prevalentes foram bactérias gram-negativas. Os óbitos foram iguais ou maiores a 50%. As mudanças de profissionais e a falta de insumos foram fatores determinantes. Conclusão: nesse contexto, ressalta-se a necessidade de qualificação permanente da equipe, com o propósito de favorecer a adesão ao protocolo e prevenir a PAV.

RESUMEN Objetivo: evaluar los impactos y factores determinantes en el cumplimiento del bundle para reducir la neumonía asociada a la ventilación mecánica (NAV). Método: se trata de un estudio descriptivo retrospectivo longitudinal con un enfoque cuantitativo, realizado en el hospital público universitario. La recolección de datos se ha llevado a cabo entre mayo de 2014 y abril de 2015. Los participantes fueron los pacientes de la UCI reportados con NAV. Para la organización de los datos se utilizó el programa Microsoft Excel 2010. Se estableció un análisis crítico de los datos recogidos y las tasas de infección. La investigación fue aprobada bajo el número de registro 566.136. Resultados: hubo un aumento en la incidencia de NAV después de la implementación del bundle; los patógenos prevalentes fueron las bacterias gramnegativas. Las muertes eran igual o superior al 50%. Cambios profesionales y la falta de insumos fueron factores determinantes. Conclusión: en este contexto, se destaca la necesidad de una formación continua del personal, con el fin de promover la adhesión al protocolo y prevenir la NAV.

ABSTRACT Objective: Assessing the determining impacts and factors in ventilator-associated pneumonia (VAP) bundle. Method: descriptive retrospective longitudinal study, with quantitative approach, held at a public teaching hospital. Collection held between May 2014 and April 2015. Patients of the ICU with VAP participated in the research. For organizing data, the Microsoft Excel 2010 program was used. A critical analysis between the data collected and infection rates was performed. The survey was approved under no. 566,136. Results: an increase in the incidence of VAP after implementing the bundle was observed; the prevalent pathogens were gram-negative bacteria. Deaths were equal to or greater than 50%. Changes of professionals and lack of supplies were determining factors. Conclusion: in this context, the need for permanent qualification of the team is emphasized, with the purpose of promoting the adherence to the protocol and preventing VAP.

Comparação entre um método de diagnóstico clínico e a técnica de vigilância do Center for Disease Control and Prevention para identificação de pneumonia associada à ventilação mecânica / Comparison between a clinical diagnosis method and the surveillance technique of the Center for Disease Control and Prevention for identification of mechanical ventilator-associated pneumonia

RESUMOObjetivo:Avaliar a concordância entre um novo método de vigilância epidemiológica do Center for Disease Control and Prevention e o Clinical Pulmonary Infection Score para detecção de pneumonia associada à ventilação mecânica.Métodos:Coorte prospectiva que avaliou pacientes internados nas unidades de terapia intensiva de dois hospitais que permaneceram intubados por mais de 48 horas no período de agosto de 2013 a junho de 2014. Os pacientes foram avaliados diariamente pelos fisioterapeutas com o Clinical Pulmonary Infection Score. De forma independente, um enfermeiro aplicou o novo método de vigilância proposto pelo Center for Disease Control and Prevention. Avaliou-se a concordância diagnóstica entre os métodos. Clinical Pulmonary Infection Score ≥ 7 foi considerado diagnóstico clínico de pneumonia associada à ventilação mecânica, considerando-se diagnóstico definitivo a associação de Clinical Pulmonary Infection Score ≥ 7 com germe isolado em cultura semiquantitativa ≥ 104 unidades formadoras de colônias.Resultados:De 801 pacientes admitidos nas unidades de terapia intensiva, 198 estiveram sob ventilação mecânica. Destes, 168 permaneceram intubados por mais de 48 horas. Identificaram-se 18 (10,7%) condições infecciosas associadas à ventilação mecânica e 14 (8,3%) pneumonias associadas à ventilação mecânica possíveis ou prováveis, representando 35% (14/38) diagnósticos clínicos de pneumonia associada à ventilação mecânica. O método do Center for Disease Control and Prevention identificou casos de pneumonia associada à ventilação mecânica com sensibilidade de 0,37 e especificidade de 1,0, com valor preditivo positivo de 1,0 e negativo de 0,84. As diferenças implicaram em discrepâncias na densidade de incidência de pneumonia associada à ventilação mecânica (CDC: 5,2/1000 dias de ventilação mecânica; Clinical Pulmonary Infection Score ≥ 7: 13,1/1000 dias de ventilação mecânica).Conclusão:O método do Center for Disease Control and Prevention falhou na detecção de casos de pneumonia associada à ventilação mecânica e pode não ser satisfatório como método de vigilância.Objective: To evaluate the agreement between a new epidemiological surveillance method of the Center for Disease Control and Prevention and the clinical pulmonary infection score for mechanical ventilator-associated pneumonia detection.

ABSTRACTObjective:>To evaluate the agreement between a new epidemiological surveillance method of the Center for Disease Control and Prevention and the clinical pulmonary infection score for mechanical ventilator-associated pneumonia detection.Methods:This was a prospective cohort study that evaluated patients in the intensive care units of two hospitals who were intubated for more than 48 hours between August 2013 and June 2014. Patients were evaluated daily by physical therapist using the clinical pulmonary infection score. A nurse independently applied the new surveillance method proposed by the Center for Disease Control and Prevention. The diagnostic agreement between the methods was evaluated. A clinical pulmonary infection score of ≥ 7 indicated a clinical diagnosis of mechanical ventilator-associated pneumonia, and the association of a clinical pulmonary infection score ≥ 7 with an isolated semiquantitative culture consisting of ≥ 104 colony-forming units indicated a definitive diagnosis.Results:Of the 801 patients admitted to the intensive care units, 198 required mechanical ventilation. Of these, 168 were intubated for more than 48 hours. A total of 18 (10.7%) cases of mechanical ventilation-associated infectious conditions were identified, 14 (8.3%) of which exhibited possible or probable mechanical ventilatorassociated pneumonia, which represented 35% (14/38) of mechanical ventilator-associated pneumonia cases. The Center for Disease Control and Prevention method identified cases of mechanical ventilator-associated pneumonia with a sensitivity of 0.37, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.84. The differences resulted in discrepancies in the mechanical ventilator-associated pneumonia incidence density (CDC, 5.2/1000 days of mechanical ventilation; clinical pulmonary infection score ≥ 7, 13.1/1000 days of mechanical ventilation).Conclusion:The Center for Disease Control and Prevention method failed to detect mechanical ventilatorassociated pneumonia cases and may not be satisfactory as a surveillance method.

Pacientes en ventilación mecánica con traqueostomía / Patients with mechanical ventilation and tracheostomy

INTRODUCCIÓN: la traqueostomía es una técnica que habitualmente se indica en enfermos críticos ingresados en las unidades de cuidados intensivos que requieren ventilación mecánica por tiempo prolongado. OBJETIVO: caracterizar algunos aspectos clínico-epidemiológicos de pacientes en ventilación mecánica que necesitaron traqueostomía. MÉTODOS: estudio observacional, descriptivo, longitudinal y retrospectivo de pacientes en ventilación mecánica que necesitaron traqueostomía, en la Unidad de Cuidados Intensivos del Hospital Militar Central "Dr. Carlos J. Finlay" entre enero de 2011 y diciembre de 2012. La muestra fue de 96 pacientes. Se revisó la base de datos de pacientes ingresados en el servicio y las historias clínicas del archivo del hospital. RESULTADOS: la edad media fue de 55,7 ± 16,9 años. Hubo un predominio del sexo masculino (59,4 %) y el grupo etario de 50-64 años (40,6 %). La hipertensión arterial constituyó el antecedente patológico más frecuente (18,8 %). Más de la mitad de los pacientes egresaron fallecidos (62,5 %); la edad media de este grupo fue superior a la de los egresados vivos (60,6 vs. 47,6 años). El motivo principal de ingreso fue no traumático (63,5 %). La media del valor del APACHE II fue de 17,4; en los fallecidos fue mayor que en los vivos (19,8 vs. 13,4). La mayoría de los pacientes estuvieron ventilados por 7 o menos días (51,0 %) y la estadía fue de 8 o más días (86,5 %). CONCLUSIONES: la traqueostomía no influyó sobre el tiempo de ventilación mecánica ni en la mortalidad global.

INTRODUCTION: tracheostomy is a technique usually indicated to manage critically ill patients who are hospitalized in Intensive care units and need mechanical ventilation for a long period of time. OBJECTIVE: to characterize some clinical and epidemiological aspects of patients with tracheostomy and mechanical ventilation. METHODS: a retrospective, longitudinal, observational and descriptive study of patients who required tracheostomy in addition to mechanical ventilation was performed at the Intensive Care Unit of "Dr. Carlos J. Finlay" Hospital from January 2011 through December 2012. The final sample was 96 patients. The database containing information of hospitalized patients in the intensive care unit as well as their medical histories were checked up. RESULTS: average age of ventilated patients was 55.7 ± 16.9 years old. Males (59.4 %) and the 50-64 years old group (40.6 %) prevailed. Hypertension proved to be the most frequent pathologic antecedent (18.8 %). More than half of the patients died at hospital (62.5 %). The average age of this group was higher than that of the discharged alive patients (60.6 vs. 47.6 years old). The non traumatic event was most common cause for hospitalization (63.5 %). The APACHE II value mean was 17, 4 and it was higher in the deceased than in the survivors (19.8 vs. 13.4). Most patients were ventilated for up to seven days (51.0 %) and stayed in the hospital for eight or more days (86.5 %). CONCLUSIONS: tracheostomy did not influence either the length of mechanical ventilation or the global mortality.

Prior oropharyngeal colonization and ventilator-associated pneumonia

This study evaluated the relationship between previous colonization of the oropharynx and development of ventilator-associated pneumonia through the classification of genomic fingerprint pattern by pulsed-field gel electrophoresis of both oxacillin-resistant and oxacillin-susceptible Staphylococcus aureus isolates obtained from hospitalized patients in an intensive care unit.

Vigilancia de infecciones asociadas a la atención en salud, resistencia bacteriana y consumo de antibióticos en hospitales de alta complejidad, Colombia, 2011 / Surveillance of healthcare associated infections, bacterial resistance and antibiotic consumption in high-complexity hospitals in Colombia, 2011

Introducción. Prevenir las infecciones adquiridas en los hospitales, en especial las causadas por microorganismos resistentes, es una prioridad. Por esta razón, Colombia inició la vigilancia nacional de estos eventos realizando una prueba piloto. Objetivo. Describir el comportamiento de las infecciones asociadas a dispositivos, resistencia bacteriana y consumo de antibióticos en instituciones con unidades de cuidados intensivos durante el 2011. Materiales y métodos. Se llevó a cabo un estudio observacional descriptivo en 10 instituciones de salud de Antioquia, Valle del Cauca y Bogotá. Se diseñaron protocolos de vigilancia para cada evento, implementados por profesionales de salud entrenados. Se diseñó una herramienta en línea para la notificación y análisis de tasas de infección, porcentajes de utilización de dispositivos y dosis diarias definidas de antibióticos. Mediante el software Whonet 5.6 se reportaron y analizaron los perfiles y fenotipos de resistencia bacteriana. Resultados. La infección del torrente sanguíneo fue la más frecuente (tasa mayor de 4,8 por 1.000 días-catéter), seguida de la neumonía asociada al respirador e infección urinaria asociada a catéter, con amplia variación entre instituciones. Se observó un mayor consumo de meropenem en las unidades de cuidados intensivos (dosis diarias definidas, 22,5 por 100 camas-día), resistencia elevada a carbapenémicos (>11,6 %) y cefalosporinas de tercera generación (>25,6 %) en enterobacterias en las unidades de cuidados intensivos y en otras áreas de hospitalización. El porcentaje de Staphylococcus aureus resistente a la meticilina fue mayor en otras áreas de hospitalización (34,3 %). Conclusiones. Se trata de la primera aproximación integral a la problemática de estos eventos en Colombia. Es necesario implementar la vigilancia nacional que permita orientar acciones gubernamentales e institucionales para la prevención y control de infecciones, contención de la resistencia y promoción del uso prudente de antibióticos acompañados de un proceso de seguimiento y supervisión.

Introduction: Preventing healthcare associated infections, especially for resistant microorganisms, is a priority. In Colombia, the surveillance of such events was started through a national pilot study. Objective: To describe the epidemiology of device-associated infections, bacterial resistance and antibiotic consumption patterns in institutions with intensive care units (ICU), 2011. Materials and methods: Descriptive observational study in 10 health institutions from three Colombian provinces: Antioquia, Valle del Cauca, and Bogotá. Surveillance protocols were designed and implemented by trained health professionals in each hospital. A web tool was designed for data reporting and analysis. Infection rates, device-use percentages and antibiotics defined daily dose (DDD) were calculated. Bacterial resistance phenotypes and profiles were reported and analyzed using Whonet 5.6. Results: The most common event was bloodstream infection (rate > 4.8/1000 catheter-days) followed by ventilator-associated pneumonia (VAP) and catheter-related urinary tract infection, showing a wide variability among institutions. A high consumption of meropenem in the ICU (DDD 22.5/100 beds-day) was observed, as well as a high carbapenem resistance (> 11.6%) and a high frequency of third generation cephalosporins resistance (> 25.6%) in Enterobacteriaceae in ICUs and hospitalization wards. The percentage of methicillin-resistant Staphylococcus aureus was higher in hospitalization wards (34.3%). Conclusions: This is the first experience in measuring these events in Colombia. It is necessary to implement a national surveillance system aimed at guiding governmental and institutional actions oriented to infection prevention and control, to resistance management and to the promotion of antibiotics rational use, along with a follow-up and monitoring process.

Estimativa da incidência de pneumonia associada à ventilação mecânica (PAV) / Estimated incidence of ventilator-associated pneumonia (VAP)

A PAV é definida como aquela que ocorre 48 horas depois que um paciente é intubado e recebe ventilação mecânica (VM) e representa uma infecção grave e frequente nas Unidades de Terapia Intensiva (UTIs) em todo o mundo. Objetivo: estimar a incidência de PAV entre as populações de risco e descrever os fatores relacionados à PAV em pacientes sob VM por ≥48 horas e ≤7 dias. Método: este foi um estudo epidemiológico, prospectivo e observacional numa população de pacientes adultos que recebem VM em três UTIs brasileiras. Resultados: de um total de 100 pacientes triados, 92 foram incluídos neste estudo que ocorreu entre 13 de maio de 2011 a 8 de novembro de 2011. Os pacientes foram seguidos por um período médio de 14,6 dias. A média de idade foi 69,5 anos, com mediana de 74,5 anos. Quarenta e quatro pacientes (47,8%) eram do sexo masculino. O diagnóstico de PAV foi feito em 30 pacientes (32,6%). Os seguintes fatores foram encontrados entre pacientes com PAV: antibioticoterapia nos últimos 90 dias antes do recrutamento, hospitalização atual ≥5 dias antes do recrutamento, altas taxas de resistência antimicrobiana na comunidade ou no hospital, hospitalização prévia ≥2 dias nos últimos três meses antes do recrutamento e procedimento dialítico crônico nos últimos 30 dias antes do recrutamento. Conclusão: apesar das medidas de prevenção, foi observada uma incidência de 5,2 casos/1.000 pacientes-dia. Os fatores relacionados à PAV neste estudo estão em conformidade com a literatura internaciona

VAP is a pneumonia that occurs 48 hours after patient intubation and receiving mechanical ventilation (MV), and it represents a severe and common infection in intensive care units (ICUs) around the world. Objective: to estimate the incidence of VAP among the population at risk and to describe the factors associated with VAP in patients on MV for ≥48 hours and ≤7 days. Method: this was an epidemiological, prospective and observational study in adults receiving MV in 3 ICUs in Brazil. Results: out of a total of 100 patients screened, 92 were included in this study that occurred between 13 May and 8 November 2011. Patients were monitored for a mean period of 14.6 days. The mean age was 69.5, with a median of 74.5. Forty-four patients (47.8 %) were male. VAP was diagnosed in 30 patients (32.6 %). The following factors were found among the patients with VAP: antibiotic therapy in the last 90 days prior to recruitment, current hospitalization ≥5 days before recruitment, high rates of antimicrobial resistance in the community or in the hospital, previous hospitalization ≥2 days in the last 3 months before the recruitment and chronic dialysis procedure in the 30 days before recruitment. Conclusion: despite preventive measures, an incidence of 5.2 cases/1000 patient-days was observed. Factors associated with VAP in this study are in accordance with the international literature

Causas de fiebre en pacientes hospitalizados en la unidad de cuidados intensivos del hospital naval almirante nef / Causes of fever In patients hospitalized in the ICU of hospital naval almirante nef

La fiebre es una anormalidad común en los pacientes hospitalizados en la unidad de cuidados intensivos. Encontrar la etiología del cuadro significa una alta demanda de recursos materiales y humanos que podrían afectar el pronóstico del paciente. Los objetivos de este trabajo fueron identificar las causas actuales de fiebre desarrollada en pacientes durante su hospitalización en la Unidad de Cuidados Intensivos Generales (UCIGEN) y describirlas según su prevalencia; categorizarlas en etiología infecciosa y no infecciosa; determinar el pronóstico según su etiología y buscar la existencia de elementos clínicos y de laboratorio que orienten a una causa infecciosa o no infecciosa. Se realizó un estudio de cohorte retrospectiva que consideró a todos los pacientes hospitalizados por7 o más días en la UCIGEN del Hospital Naval Almirante Nef y que egresaron de ella entre julio del año 2007 y julio del año 2012. De un total de 386 pacientes, 82 presentaron fiebre (21,24 por ciento) y en 10 de ellos (12,20 por ciento) no se logró determinar la causa. En los 72 pacientes (87,80 por ciento) que tuvieron una causa conocida, 67 casos fueron de etiología infecciosa y 5 de etiología no infecciosa. La principal causa de fiebre fue la neumonía asociada a ventilación mecánica (31,76 por ciento), seguida de la infección con uno o más microorganismos diferentes en más de un foco infeccioso (12,20 por ciento). No hubo relación estadísticamente significativa entre la etiología de la fiebre y elementos clínicos ni de laboratorio, como tampoco entre el pronóstico y la etiología (OR =0,684; IC 95 por ciento = 0,073 - 8.816). En conclusión, la fiebre desarrollada en los pacientes de la UCIGEN es predominantemente de origen infeccioso cuya causa más frecuente es la neumonía asociada a ventilación mecánica. Se recomienda orientar la búsqueda hacia una etiología infecciosa,...

Fever is a common abnormality in the ICU patients. Finding the fever etiology means a high demand of material and human resources that could affect the patient prognosis. The objectives of this investigation were to identify the actual causes of fever developed in patients during their hospitalization in the ICU and describe them according to their prevalence; categorize them according in infectious and noninfectious etiology; determinate their prognosis according to their etiology and find the existence of clinical and laboratory elements to guide a cause infectious or noninfectious. A retrospective cohort study was realized that considered 386 patients hospitalized for 7 or more days at the Hospital Naval Almirante Nef ICU and were discharged from it in July of 2007 and July of 2012. From a total of 386 patients, 82 did fever (21.24 percent) and in 10 of them (12.20 percent) were not able to determine the cause, of the 72 patients (87.80 percent) who had a known cause, 67 cases were due to infection and only 5 cases due to a non-infectious cause. Of all patients who developed fever, the leading cause was mechanical ventilation-associated pneumonia (31.76 percent), followed by infection with one or more isolated microrganism (12.20 percent). There was no statistically significant relationship between the etiology of fever and clinical or laboratory items, nor there was between the prognosis and etiology (OR = 0.684, 95 percent CI = 0.073-8.816). In conclusion the currently fever developed in ICU patients is predominantly due to an infectious cause and is most often caused by mechanical ventilation-associated pneumonia. It is recommended to guide the search for an infectious etiology,...

Reducción de incidencia de neumonía asociada a ventilación mecánica post cirugía cardíaca: experiencia de 13 años de vigilancia epidemiológica en un hospital universitario / Reducing the incidence of ventilator-associated pneumonia following heart surgery: 13-year experience of epidemiologic surveillance in a teaching hospital

Objectives: To report the results of 13 years worth of epidemiologic surveillance of ventilator-associated pneumonia (VAP) following heart surgery and the main interventions applied in order to reduce VAP incidence. Methods: This is a retrospective and descriptive study of active epidemiologic surveillance of VAP. National diagnostic criteria were used. Interventions associated with a decrease in VAlP incidence in adults who underwent heart surgery are described. Results: A significant and sustained reduction was observed in the rate of VAP; being 56.7 per 1,000 ventilator-days in 1998 vs 4.7 per 1,000 ventilator-days in 2010 (p < 0.001). The strongest reduction was observed following 2003 (34.4 to 14.8 per 1,000 ventilator-days in 2004, p < 0.001). The interventions with greatest impact were the implementation of an early-weaning protocol, the introduction of trained nurses to perform the mechanical ventilator equipment management and the routine use of alcohol-based hand rubs. Conclusion: Epidemiologic surveillance associated with the establishment of a multifactorial intervention program applied in collaboration with the attending team, have demonstrated a significant reduction of VAP incidence after heart surgery.

Objetivos: Comunicar los resultados de 13 años de vigilancia epidemiológica de neumonía asociada a ventilación mecánica (NAVM) post cirugía cardíaca y las principales intervenciones implementadas para reducir su incidencia. Metodología: Estudio retrospectivo, descriptivo, de vigilancia epidemiológica activa de NAVM utilizando los criterios del ]Ministerio de Salud (MINSAL) y de las intervenciones asociadas con una disminución de la tasa de NAVM en adultos operados de cirugía cardíaca. Resultados: Se observó una reducción significativa y sostenida de la tasa de NAVM, siendo 56,7 por 1.000 días de ventilación mecánica (VM) en 1998 vs 4,7 por 1.000 días de VM en 2010 (p < 0,001). La mayor reducción fue observada a partir de 2003 (desde 34,4 a 14,8 por 1.000 días de VM en 2004, p < 0,001). Las intervenciones con mayor impacto fueron la implementación de un protocolo de extubación precoz, la incorporación de enfermeras capacitadas en el manejo de los equipos de VM y el uso rutinario de alcohol gel. Conclusión: La vigilancia epidemiológica asociada a un programa de intervención multifactorial aplicado en conjunto con el equipo tratante permitió reducir significativamente la incidencia de NAVM post cirugía cardíaca.