Manejo del paciente con neumonia grave en ventilación mecánica: utilidad del lavado broncoalveolar / Management of the patients with severe pneumonia in mechanical ventilation: useful of bronchoalveolar lavage

To assess the diagnostic value of bronchoalveolar lavage (BAL) in patients with suspicion of bacterial pneumonia in mechanical ventilation, we evaluated 73 community-acquired pneumonia and 94 nosocomial pneumonia in critically ill and mechanically ventilated patients. The mortality was 50 percent (82 patients) and the principal deth's cause was pulmonary sepsis (90 percent). 157 subjects received antibiotic before the microbiologic exam (94 percent) and 30 patients had multiple organ failure (MOF). 70 of 167 BAL culture samples demonstrated microbial growth of >10 to 4 cfu/ml (sensitivity: 41.9 percent). BAL culture samples isolated gram-positive cocci in 27 cases (39 percent), aerobic gram-negative bacilli in 39 cases (57 percent) and P carinii in 3 cases (4 percent). Correlation between BAL culture and hemocultive results was very insignificant. Prognosis of community-acquired pneumonia and nosocomial pneumonia were very bad in both cases. Mortality of patients with MOF (73 percent) was higher than patients without MOF (44,8 percent), (p<0.01). Mortality was similar in patients with BAL culture positive (48,6 percent) and negative (49,5 percent). The mortality rate of severe pneumonia in MV was very elevated and the BAL culture results didn't affect significatively the survival

Indices predictores del retiro precoz de ventilación mecánica en pacientes sometidos a cirugía cardíaca / Predictor rates of early mechanical ventilation withdrawal in patients submitted to cardiac surgery

To study the capacity to predict successful early extubation of ventilatory and gas exchange parameters, 230 patients admitted to an intensive care unit after coronary or valvular surgery were studied. Measurements were made through a T piece 30 minutes after discontinuing mechanical ventilation. Six patients died in the postoperative period. Two hundred ten patients tolerated early extubation (14ñ5 h of mechanical ventilation) and 20 required prolonged mechanical ventilation (74ñ107 h). The latter had longer surgical procedures (291ñ65 and 240ñ67 min respectively) and extracorporeal circulation times (138ñ42 and 104ñ43 min respectively), required more vasoactive drugs, had more episodes of confusion and had a higher surgical risk. Tidal volume, respiratory frequency, maximal inspiratory pressure and blood gases at the moment of extubation were similar in both groups. Pulmonary function parameters and blood gases measured during a T piece trial are not good predictors of early extubation in cardiac surgery