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Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial / Cultura quantitativa de aspirado traqueal e lavado broncoalveolar no manejo de pacientes com pneumonia associada à ventilação mecânica: um ensaio clínico randomizado
Corrêa, Ricardo de Amorim; Luna, Carlos Michel; Anjos, José Carlos Fernandez Versiani dos; Barbosa, Eurípedes Alvarenga; Rezende, Cláudia Juliana de; Rezende, Adriano Pereira; Pereira, Fernando Henrique; Rocha, Manoel Otávio da Costa.
  • Corrêa, Ricardo de Amorim; Federal University of Minas Gerais. School of Medicine. Department of Pulmonology and Thoracic Surgery. Belo Horizonte. BR
  • Luna, Carlos Michel; Federal University of Minas Gerais. School of Medicine. Department of Pulmonology and Thoracic Surgery. Belo Horizonte. BR
  • Anjos, José Carlos Fernandez Versiani dos; Federal University of Minas Gerais. School of Medicine. Department of Pulmonology and Thoracic Surgery. Belo Horizonte. BR
  • Barbosa, Eurípedes Alvarenga; Federal University of Minas Gerais. School of Medicine. Department of Pulmonology and Thoracic Surgery. Belo Horizonte. BR
  • Rezende, Cláudia Juliana de; Federal University of Minas Gerais. School of Medicine. Department of Pulmonology and Thoracic Surgery. Belo Horizonte. BR
  • Rezende, Adriano Pereira; Federal University of Minas Gerais. School of Medicine. Department of Pulmonology and Thoracic Surgery. Belo Horizonte. BR
  • Pereira, Fernando Henrique; Federal University of Minas Gerais. School of Medicine. Department of Pulmonology and Thoracic Surgery. Belo Horizonte. BR
  • Rocha, Manoel Otávio da Costa; Federal University of Minas Gerais. School of Medicine. Department of Pulmonology and Thoracic Surgery. Belo Horizonte. BR
J. bras. pneumol ; 40(6): 643-651, Nov-Dec/2014. tab
Article in English | LILACS | ID: lil-732554
ABSTRACT

OBJECTIVE:

To compare 28-day mortality rates and clinical outcomes in ICU patients with ventilator-associated pneumonia according to the diagnostic strategy used.

METHODS:

This was a prospective randomized clinical trial. Of the 73 patients included in the study, 36 and 37 were randomized to undergo BAL or endotracheal aspiration (EA), respectively. Antibiotic therapy was based on guidelines and was adjusted according to the results of quantitative cultures.

RESULTS:

The 28-day mortality rate was similar in the BAL and EA groups (25.0% and 37.8%, respectively; p = 0.353). There were no differences between the groups regarding the duration of mechanical ventilation, antibiotic therapy, secondary complications, VAP recurrence, or length of ICU and hospital stay. Initial antibiotic therapy was deemed appropriate in 28 (77.8%) and 30 (83.3%) of the patients in the BAL and EA groups, respectively (p = 0.551). The 28-day mortality rate was not associated with the appropriateness of initial therapy in the BAL and EA groups (appropriate therapy 35.7% vs. 43.3%; p = 0.553; and inappropriate therapy 62.5% vs. 50.0%; p = 1.000). Previous use of antibiotics did not affect the culture yield in the EA or BAL group (p = 0.130 and p = 0.484, respectively).

CONCLUSIONS:

In the context of this study, the management of VAP patients, based on the results of quantitative endotracheal aspirate cultures, led to similar clinical outcomes to those obtained with the results of quantitative BAL fluid cultures. .
RESUMO

OBJETIVO:

Comparar a mortalidade em 28 dias e desfechos clínicos em pacientes com pneumonia associada à ventilação mecânica (PAVM) internados em UTI conforme a estratégia diagnóstica utilizada.

MÉTODOS:

Ensaio clínico randomizado prospectivo. Dos 73 pacientes incluídos no estudo, 36 e 37, respectivamente, foram randomizados para a realização de LBA ou aspiração traqueal (AT). A antibioticoterapia inicial baseou-se em diretrizes e foi ajustada de acordo com os resultados das culturas quantitativas.

RESULTADOS:

A taxa de mortalidade em 28 dias foi semelhante nos grupos LBA e AT (25,0% e 37,8%, respectivamente; p = 0,353). Não houve diferenças entre os grupos em relação a duração da ventilação mecânica, antibioticoterapia, complicações secundárias, recidiva de PAVM ou tempo de permanência hospitalar e na UTI. A antibioticoterapia inicial foi considerada adequada em 28 (77,8%) e 30 (83,3%) dos pacientes nos grupos LBA e AT, respectivamente (p = 0,551). A mortalidade em 28 dias não se associou com a adequação da antibioticoterapia inicial nos grupos LBA e AT (tratamento apropriado 35,7% vs. 43,3%; p = 0,553; e tratamento inapropriado 62,5% vs. 50,0%; p = 1,000). O uso prévio de antibióticos não interferiu no rendimento das culturas nos grupos AT e LBA (p = 0,130 e p = 0,484, respectivamente).

CONCLUSÕES:

No contexto deste estudo, o manejo dos pacientes com PAVM, baseado nos resultados da cultura quantitativa do aspirado traqueal, resultou em desfechos clínicos semelhantes aos obtidos com os resultados da cultura quantitativa do LBA. (Registro Brasileiro de Ensaios ...
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Respiration, Artificial / Bronchoalveolar Lavage Fluid / Pneumonia, Ventilator-Associated Type of study: Controlled clinical trial / Practice guideline / Observational study / Risk factors Limits: Aged / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: J. bras. pneumol Journal subject: Pulmonary Disease (Specialty) Year: 2014 Type: Article Affiliation country: Brazil Institution/Affiliation country: Federal University of Minas Gerais/BR

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Full text: Available Index: LILACS (Americas) Main subject: Respiration, Artificial / Bronchoalveolar Lavage Fluid / Pneumonia, Ventilator-Associated Type of study: Controlled clinical trial / Practice guideline / Observational study / Risk factors Limits: Aged / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: J. bras. pneumol Journal subject: Pulmonary Disease (Specialty) Year: 2014 Type: Article Affiliation country: Brazil Institution/Affiliation country: Federal University of Minas Gerais/BR