RESUMO
Objetivo Analizar factores de riesgo de fracaso de la ventilación no invasiva (VNI) en pacientes que ingresan en una unidad de cuidados intensivos (UCI) por neumonía primaria por virus influenza A (H1N1)pdm09. Demostrar que los pacientes que fracasan con la VNI tienen mayor mortalidad y estancias más largas. Diseño Estudio de cohorte. Ámbito UCI polivalente de un hospital universitario de 16 camas. Pacientes Pacientes adultos que ingresaron en la UCI en los que se confirmó el diagnóstico de neumonía por influenza A (H1N1)pdm09 y que recibieron ventilación mecánica. Variables Edad, sexo, puntuaciones de gravedad, administración de corticoides, oseltamivir dentro de las 72h de la sintomatología, días de sintomatología previos al ingreso, cuadrantes afectados, fracaso hemodinámico, renal y datos analíticos al ingreso, mortalidad y estancia en UCI y hospitalaria. Resultados Ingresaron 54 pacientes y 49 fueron ventilados. Sexo femenino, 29 (59,2%) y una edad media±desviación estándar de 66,77±14,77 años. Fueron ventilados con VNI 43 (87,75%), de los que fracasaron 18 (41,9%). Los pacientes que fracasaron presentaron menor edad (63 vs. 74 años; p=0,04), mayor puntuación SOFA (7 vs. 4; p=0,01) y mayor fracaso hemodinámico (61,1 vs. 8%; p=0,01). Además, presentaron estancias más largas tanto en UCI (26,28 vs. 6,88 días; p=0,01) como hospitalarias (32,78 vs. 18,8 días; p=0,01), y mayor mortalidad en UCI (38,9 vs. 0%; p=0,02). Se identificaron como factores de riesgo de fracaso a VNI recibir corticoides (OR 7,08; IC 95% 1,23-40,50) y el fallo hemodinámico precoz (OR 14,77; IC 95% 2,34-92,97). Conclusiones El tratamiento con corticoides y el fracaso hemodinámico precoz se asociaron con el fracaso de la VNI en pacientes con neumonía primaria por virus influenza A (H1N1)pdm09. Estos tienen una mortalidad superior. (AU)
Objective To evaluate the risk factors associated to noninvasive mechanical ventilation (NIV) failure in patients with primary pneumonia due to influenza A (H1N1)pdm09 virus admitted to the intensive care unit (ICU), and to demonstrate the association of NIV failure to increased mortality and longer stays. Design A cohort study was carried out. Scope A mixed ICU (16 beds) in a teaching hospital. Patients Adult patients admitted to the ICU with a diagnosis of pneumonia due to influenza A (H1N1)pdm09 virus requiring mechanical ventilation. Measurements Age, sex, severity scores, administration of corticosteroids, oseltamivir within 72h of symptoms onset, days of symptoms prior to admission, affected quadrants, hemodynamic parameters, renal failure, laboratory test data on admission, mortality and stay in ICU and in hospital. Results A total of 54 patients were admitted to the ICU and 49 were ventilated; 29 were females (59.2%), and the mean age±standard deviation was 66.77±14.77 years. Forty-three patients (87.75%) were ventilated with NIV, and 18 (41.9%) of them failed. Patients with NIV failure were younger (63 vs. 74 years; P=.04), with a higher SOFA score (7 vs. 4; P=.01) and greater early hemodynamic failure (61.1 vs. 8%; P=.01). In addition, they presented longer ICU (26.28 vs. 6.88 days; P=.01) and hospital stay (32.78 vs. 18.8 days; P=.01). The ICU mortality rate was also higher in the NIV failure group (38.9 vs. 0%; P=.02). In the multivariate analysis, corticosteroid therapy (OR 7.08; 95% CI 1.23-40.50) and early hemodynamic failure (OR 14.77; 95% CI 2.34-92.97) were identified as independent risk factors for NIV failure. Conclusions Treatment with corticosteroids and early hemodynamic failure were associated to NIV failure in patients with primary pneumonia due to influenza A (H1N1)pdm09 virus infection admitted to the ICU. The failure of NIV was associated to increased mortality. (AU)
Assuntos
Humanos , Influenza Humana , Ventilação não Invasiva , Fatores de Risco , MortalidadeRESUMO
OBJECTIVE: To evaluate the risk factors associated to noninvasive mechanical ventilation (NIV) failure in patients with primary pneumonia due to influenza A (H1N1)pdm09 virus admitted to the intensive care unit (ICU), and to demonstrate the association of NIV failure to increased mortality and longer stays. DESIGN: A cohort study was carried out. SCOPE: A mixed ICU (16 beds) in a teaching hospital. PATIENTS: Adult patients admitted to the ICU with a diagnosis of pneumonia due to influenza A (H1N1)pdm09 virus requiring mechanical ventilation. MEASUREMENTS: Age, sex, severity scores, administration of corticosteroids, oseltamivir within 72h of symptoms onset, days of symptoms prior to admission, affected quadrants, hemodynamic parameters, renal failure, laboratory test data on admission, mortality and stay in ICU and in hospital. RESULTS: A total of 54 patients were admitted to the ICU and 49 were ventilated; 29 were females (59.2%), and the mean age±standard deviation was 66.77±14.77 years. Forty-three patients (87.75%) were ventilated with NIV, and 18 (41.9%) of them failed. Patients with NIV failure were younger (63 vs. 74 years; p=0.04), with a higher SOFA score (7 vs. 4; p=0.01) and greater early hemodynamic failure (61.1 vs. 8%; p=0.01). In addition, they presented longer ICU (26.28 vs. 6.88 days; p=0.01) and hospital stay (32.78 vs. 18.8 days; p=0.01). The ICU mortality rate was also higher in the NIV failure group (38.9 vs. 0%; p=0.02). In the multivariate analysis, corticosteroid therapy (OR 7.08; 95% CI 1.23-40.50) and early hemodynamic failure (OR 14.77; 95% CI 2.34-92.97) were identified as independent risk factors for NIV failure. CONCLUSIONS: Treatment with corticosteroids and early hemodynamic failure were associated to NIV failure in patients with primary pneumonia due to influenza A (H1N1)pdm09 virus infection admitted to the ICU. The failure of NIV was associated to increased mortality.
Assuntos
Vírus da Influenza A Subtipo H1N1 , Influenza Humana , Ventilação não Invasiva , Pneumonia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Cuidados Críticos , Feminino , Mortalidade Hospitalar , Humanos , Influenza Humana/terapia , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
No disponible
Assuntos
Humanos , Infecções por Coronavirus/terapia , Fatores de Risco , Infecções Respiratórias/prevenção & controle , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/normas , Máscaras/normas , Insuficiência Respiratória/complicações , Desenho de Equipamento , Infecção Hospitalar/prevenção & controleAssuntos
Betacoronavirus , Infecções por Coronavirus/transmissão , Ventilação não Invasiva/efeitos adversos , Pneumonia Viral/transmissão , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Humanos , Máscaras , Ventilação não Invasiva/instrumentação , Doenças Profissionais/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , SARS-CoV-2RESUMO
No disponible
Assuntos
Humanos , Anti-Infecciosos/uso terapêutico , Cuidados Críticos , Antibacterianos , Anti-InfecciososAssuntos
Gestão de Antimicrobianos , Cuidados Críticos , Antibacterianos , Anti-Infecciosos , HumanosRESUMO
No disponible
Assuntos
Humanos , Cuidados Críticos/métodos , Infecções Comunitárias Adquiridas , Estado Terminal , Infecção Hospitalar , Prognóstico , Fatores de RiscoAssuntos
Doenças Transmissíveis/epidemiologia , Cuidados Críticos/métodos , Estado Terminal , Doenças Transmissíveis/microbiologia , Doenças Transmissíveis/virologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Cuidados Críticos/tendências , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/virologia , Humanos , Controle de Infecções , Tempo de Internação , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Prognóstico , Fatores de RiscoRESUMO
No disponible
Assuntos
Humanos , Infecções/terapia , Índice de Gravidade de Doença , Estado TerminalRESUMO
Objetivo: En los últimos años se ha constatado un incremento en las infecciones causadas por cocos gram positivos en pacientes críticos, junto a un rápido desarrollo de resistencias a los antibióticos habitualmente empleados para su tratamiento. El objetivo es elaborar una guía de tratamiento antibiótico de las infecciones más frecuentes causadas por cocos gram positivos en pacientes críticos, que ayude a la toma de decisiones asistenciales.Método: Expertos de dos grupos de trabajo de dos sociedades científicas, pertenecientes al Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC (GEIPC-SEIMC) y al Grupo de Trabajo de Enfermedades Infecciosas de la SEMICYUC (GTEI-SEMICYUC),se reunieron con el objetivo de elaborar un documento de consenso. Se hizo una revisión sistemática de la literatura publicada hasta septiembre de 2006 referida a estas infecciones, y con los tratamientos antibióticos comercializados hasta entonces. Se aplicó un sistema de graduación de la evidencia según la fuerza de la recomendación (categorías A, B o C) y el grado de evidencia (categorías I, II o III). Se realizaron las recomendaciones por consenso entre los expertos de ambas sociedades.Resultados: Se presentan en forma de tablas las pautas antibióticas recomendadas para el tratamiento de las infecciones causadas por cocos gram positivos, reflejando el grado de recomendación. Se expresan las alternativas para el caso de pacientes alérgicos. En el texto se razona la base científica sobre la que se sustentan dichas recomendaciones citando las referencias en las que se apoyan.Conclusiones: Se presenta el resumen de una guía práctica, basada en la evidencia, para el tratamiento antibiótico de infecciones por cocos gram positivos en el paciente crítico
Objective: In recent years there has been an increase in infections caused by gram-positive cocci in critical patients, together with a rapid development of resistance to the antibiotics which arenormally used to treat them. The objective is to prepare an antibiotic treatment guide for the most common infections caused bygram positive cocci in critical patients. This guide will help in the decision-making process regarding the care of such patients.Method: Experts from two scientific societies worked together to prepare a consensus document. They were members of the Study Group on Infections in Critical Patients (GEIPC), which is part of the Spanish Society of Infectious Diseases and Clinical Microbiology(SEIMC), and the Infectious Diseases Working Group (GTEI), belonging to the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC). There was a systematic review of the literature published up to September 2006 regarding this type of infections and the antibiotic treatments marketed to that date. An evidence grading system was applied according to the strength of the recommendation (categories A, B or C) and the level of evidence (categories I, II or III). Recommendations were given if there was consensus among the experts from both societies.Results: The antibiotic regimens recommended for treatinginfections caused by gram-positive cocci were presented in the form of tables, showing the recommendation grade. Alternatives were given for allergic patients. The scientific basis supporting the aforementioned recommendations is explained within the text and the references upon which they are based are cited.Conclusions: A summary of an evidence-based practicalguide for the treatment of infections caused by gram-positive cocci in critical patients is presented
Assuntos
Humanos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Cuidados Críticos/métodos , Antibacterianos/uso terapêutico , Cocos Gram-Positivos , Padrões de Prática Médica , Estado Terminal/terapia , ConsensoRESUMO
In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Critico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients.
Assuntos
Antibacterianos/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Cateterismo/efeitos adversos , Infecções Bacterianas do Sistema Nervoso Central/tratamento farmacológico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Estado Terminal , Infecção Hospitalar/tratamento farmacológico , Endocardite Bacteriana/tratamento farmacológico , Humanos , Pneumonia Bacteriana/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológicoRESUMO
En los últimos años se ha constatado un incremento en las infecciones causadas por cocos grampositivos tanto en infecciones comunitarias como nosocomiales. En algunos países, se ha observado un rápido desarrollo de resistencias a los antibióticos habitualmente empleados para su tratamiento, y se supone que esa situación puede llegar en el futuro a nuestro país. Se están desarrollando nuevos antimicrobianos específicamente dirigidos para el tratamiento de estas infecciones, pero es necesario profundizar en el conocimiento de las propiedades farmacocinéticas de los antibióticos tanto antiguos como nuevos, para aprovechar al máximo sus cualidades frente a estos patógenos y evitar en lo posible su toxicidad. En el paciente crítico estos problemas son más acuciantes, ya que la inadecuación del tratamiento, tanto en la elección del antibiótico como en la dosis y en la administración, se acompañan frecuentemente de fracasos terapéuticos y por tanto de mal pronóstico. Expertos de dos grupos de trabajo de dos Sociedades científicas, pertenecientes al Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC (GEIPC-SEIMC) y al Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC (GTEI- SEMICYUC) se han reunido con el objetivo de elaborar un documento de consenso, basado en la evidencia científica, que recoge las recomendaciones para el tratamiento antibiótico de las infecciones graves causadas por cocos grampositivos en el paciente crítico y que ayude en la toma de decisiones asistenciales
In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Critico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients
Assuntos
Humanos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Cocos Gram-Positivos/patogenicidade , Antibacterianos/uso terapêutico , Resistência a Medicamentos , Medicina Baseada em Evidências/métodos , Estado Terminal/terapia , Infecções Bacterianas do Sistema Nervoso Central/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Bacteriemia/tratamento farmacológicoRESUMO
En los últimos años se ha constatado un incremento en las infecciones causadas por cocos grampositivos tanto en infecciones comunitarias como nosocomiales. En algunos países, se ha observado un rápido desarrollo de resistencias a los antibióticos habitualmente empleados para su tratamiento, y se supone que esa situación puede llegar en el futuro a nuestro país. Se están desarrollando nuevos antimicrobianos específicamente dirigidos para el tratamiento de estas infecciones, pero es necesario profundizar en el conocimiento de las propiedades farmacocinéticas de los antibióticos tanto antiguos como nuevos, para aprovechar al máximo sus cualidades frente a estos patógenos y evitar en lo posible su toxicidad. En el paciente crítico estos problemas son más acuciantes, ya que la inadecuación del tratamiento, tanto en la elección del antibiótico como en la dosis y en la administración, se acompañan frecuentemente de fracasos terapéuticos y por tanto de mal pronóstico. Expertos de dos grupos de trabajo de dos Sociedades científicas, pertenecientes al Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC (GEIPC-SEIMC) y al Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC (GTEI-SEMICYUC) se han reunido con el objetivo de elaborar un documento de consenso, basado en la evidencia científica, que recoge las recomendaciones para el tratamiento antibiótico de las infecciones graves causadas por cocos grampositivos en el paciente crítico y que ayude en la toma de decisiones asistenciales (AU)
In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired-infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients (AU)
Assuntos
Humanos , Cocos Gram-Positivos/patogenicidade , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Antibacterianos/farmacocinética , Cuidados Críticos/métodos , Resistência a Medicamentos , Infecções Bacterianas do Sistema Nervoso Central/tratamento farmacológico , Insuficiência Renal Crônica/tratamento farmacológico , Testes de Sensibilidade MicrobianaRESUMO
OBJECTIVE: In recent years there has been an increase in infections caused by gram-positive cocci in critical patients, together with a rapid development of resistance to the antibiotics which are normally used to treat them. The objective is to prepare an antibiotic treatment guide for the most common infections caused by gram positive cocci in critical patients. This guide will help in the decision-making process regarding the care of such patients. METHOD: Experts from two scientific societies worked together to prepare a consensus document. They were members of the Study Group on Infections in Critical Patients (GEIPC), which is part of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and the Infectious Diseases Working Group (GTEI), belonging to the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC). There was a systematic review of the literature published up to September 2006 regarding this type of infections and the antibiotic treatments marketed to that date. An evidence grading system was applied according to the strength of the recommendation (categories A, B or C) and the level of evidence (categories I, II or III). Recommendations were given if there was consensus among the experts from both societies. RESULTS: The antibiotic regimens recommended for treating infections caused by gram-positive cocci were presented in the form of tables, showing the recommendation grade. Alternatives were given for allergic patients. The scientific basis supporting the aforementioned recommendations is explained within the text and the references upon which they are based are cited. CONCLUSIONS: A summary of an evidence-based practical guide for the treatment of infections caused by gram-positive cocci in critical patients is presented.