Carrillo ER, Ojino SJ, Carrillo CJR, Carrillo CLD

Idioma: Español
Referencias bibliográficas: 41
Paginas: 131-136
Archivo PDF: 239.76 Kb.

RESUMEN

La Neumonía Asociada a Ventilador (NAV) es una de las principales complicaciones infecciosas en la Unidad de Terapia Intensiva (UTI) con una elevada morbimortalidad. Su diagnóstico y manejo es complejo, por lo que su prevención es la piedra angular en la práctica clínica cotidiana. Hay suficiente evidencia científica que recomienda que una serie de intervenciones realizadas de manera protocolizada de manera profiláctica disminuyen su incidencia. Estas estrategias son farmacológicas y no farmacológicas y se enfocan en la prevención de la colonización de la faringe y vía aérea y de la aspiración de la secreción orofaríngea, en especial la subglótica. Otros componentes importantes de este proceso profiláctico incluyen el lavado de manos, la implementación de un programa educacional entre el personal de UTI, la optimización de recursos, el uso racional y en protocolo acortado de antibióticos, limitación de la sedación, retiro protocolizado de la ventilación mecánica, el empleo de ventilación no invasiva, la posición de semifowller, el adecuado manejo de los circuitos de ventilación y la adecuación y protocolización de otras prácticas como la transfusión, control de glucosa, nutrición, profilaxis antiulcerosa y tromboembólica. Una adecuada implementación de este protocolo impactará en la reducción en la incidencia de NAV y en los costos de atención en la UTI.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Wenzel RP. Hospital-acquired pneumonia: overview of the current state of the art for prevention and control. Eur J Clin Microbiol Infect Dis 1989; 8: 56-60.

2. Rello J, Quintana E, Ausina V, et al. Incidence, etiology, and outcome of nosocomial pneumonia in mechanically ventilated patients. Chest 1991; 100: 439-44.

3. Johanson WG, Pierce AK, Sanford JP. Changing pharyngeal flora of hospitalized patients. Emergence of gram-negative bacilli. N Engl J Med 1969; 281: 1137-40.

4. Johanson WG Jr, Pierce AK, Sanford JP, Thomas GD. Nosocomial respiratory infections with gram-negative bacilli. The significance of colonization of the respiratory tract. Ann Intern Med 1972; 77: 701-6.

5. Craven DE, Steger KA, Barber TW. Preventing nosocomial pneumonia: state of the art and perspectives. Am J Med 1991; 91: 44-54.

6. Mahul P, Auboyer C, Jospe R, et al. Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Med 1992; 18: 20-5.

7. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999; 27: 887-92.

8. Cross AS, Roup B. Role of respiratory assistance devices in endemic nosocomialpneumonia. Am J Med 1981; 70: 681-5.

9. Celis R, Torres A, Gatell JM, Almela M, Rodriguez-Riosin R, Agusti-Vidal A. Nosocomial pneumonia. A multivariate analysis of risk and prognosis. Chest 1988; 93: 318-24.

10. Chevret S, Hemmer M, Carlet J, Langer M. Incidence and risk factors of pneumonia acquired in intensive care units. Results from a multicenter prospective study on 996 patients. European Cooperative Group on Nosocomial Pneumonia. Intensive Care Med 1993; 19: 256-64.

11. Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993; 94: 281-8.

12. Leu HS, Kaiser DL, Mori M, Woolson RF, Wenzel RP. Hospitalacquired pneumonia. Attributable mortality and morbidity. Am J Epidemiol 1989; 129: 1258-67.

13. Heyland DK, Cook DJ, Griffith L, Keenan SP, Brun-Buisson C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group. Am J Respir Crit Care Med 1999; 159: 1249-56.

14. Fagon JY, Chastre J, Domart Y, Trouillet JL, Gibert C. Mortality due to ventilatorassociated pneumonia or colonization with Pseudomonas or Acinetobacter species: assessment by quantitative culture of samples obtained by a protected specimen brush. Clin Infect Dis 1996; 23: 538-42.

15. Rello J, Ollendorf DA, Osler G. Epidemiology and outcomes of ventilatorassociated pneumonia in a large US database. Chest 2002; 122: 2115-21.

16. Cook DJ, Walter SD, Cook RJ. Incidence of and risk factors for ventilatorassociated pneumonia in critically ill patients. Ann Intern Med 1998; 129: 433-40.

17. Craven DE, Kunches LM, Kilinsky V, Lichtenberg DA, Make BJ, McCabe WR. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 1986; 133: 792-6.

18. Zack JE, Garrison T, Trovillion E, et al. Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Crit Care Med 2002; 30: 2407-12.

19. Chastre J. Conference Summary: Ventilator-Associated Pneumonia. Respiratory Care 2005; 50: 975-83.

20. Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K. Nurse-staffing levels and the quality of care in hospitals. N Engl J Med 2002; 346: 1715-22.

21. Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care–associated pneumonia, 2003. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004; 53(RR-3): 1-36.

22. Girou E, Loyeau S, Legrand P, Oppein F, Brun-Buisson C. Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial. BMJ 2002; 325: 362-5.

23. Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D. Comparison of 8 vs 15 days of antibiotic therapy for ventilatorassociated pneumonia in adults: a randomized trial. JAMA 2003; 290(19): 2588-98.

24. Struelens MJ, Byl B, Vincent JL. Antibiotic policy: a tool for controlling resistance of hospital pathogens. Clin Microbiol Infect 1999; 5 Suppl 1: S19-S24.

25. Shorr AF, Duh MS, Kelly KM, Kollef MH. CRIT Study Group. Red blood cell transfusion and ventilator-associated pneumonia: a potential link? Crit Care Med 2004; 32: 666-74.

26. Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients un- dergoing mechanical ventilation. N Engl J Med 2000; 342: 1471-7.

27. Kollef MH, Shapiro SD, Silver P, St John RE, Prentice D, Sauer S. A randomized, controlled trial of protocol-directed versus physician- directed weaning from mechanical ventilation. Crit Care Med 1997; 25: 567-74.

28. Girou E, Schortgen F, Delclaux C, Brun-Buisson C, Blot F, Lefort Y. Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA 2000; 284: 2361-7.

29. Rouby JJ, Laurent P, Gosnach M, Cambau E, Lamas G, Zouaoui A. Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill. Am J Respir Crit Care Med 1994; 150: 776-83.

30. Rouby JJ, Laurent P, Gosnach M, Cambau E, Lamas G, Zouaoui A. Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill. Am J Respir Crit Care Med 1994; 150: 776-83.

31. Rello J, Sonora R, Jubert P, Artigas A, Rue M, Valles J. Pneumonia in intubated patients: role of respiratory airway care. Am J Respir Crit Care Med 1996; 154: 111-15.

32. Torres A, Gatell JM, Aznar E, El-Ebiary M, Puig de la Bellacasa J, Gonzalez J. Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 1995; 152: 137-41.

33. Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 1999; 354: 1851-8.

34. DeRiso AJ 2nd, Ladowski JS, Dillon TA, Justice JW, Peterson AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 1996; 109: 1556-61.

35. Craven DE, Goularte TA, Make BJ. Contaminated condensate in mechanical ventilator circuits: a risk factor for nosocomial pneumonia? Am Rev Respir Dis 1984; 129: 625-8.

36. Kollef MH, Afessa B, Anzueto A, et al. NASCENT Investigation Group. Silver-coated endotracheal tubes and incidente of ventilador- associated penumonia: The NASCENT randomized trial. JAMA 2008; 300: 805-13.

37. Vallés J, Artigas A, Rello J, Bonsoms N, Fontanals D. Contínuos aspiration of subglotic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 1995; 122: 179-86.

38. Bouza E, Pérez MJ, Muñoz P, Rincón C, Barrio JM, Hortal J. Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery. Chest 2008; 938-46.

39. Yang CS, Qiu HB, Zhu YP, Huang YZ. Effect of continuous aspiration of subglottic secretions on the prevention of ventilator- associated pneumonia in mechanically ventilated patients: a prospective, randomized, controlled clinical trial. Zhonghua Nei Za Zhi 2008; 47: 625-9.

40. Depew CL, McCarthy MS. Subglotic secresion drainage: a literature review. AACN Adv Crit Care 2007; 18: 366-79.

41. Lorente L, Lecuona M, Jiménez A, Mora ML, Sierra A. Influence of an endotracheal tube with polyurethane cuff and subglottic secresion drainage on pneumonia. Am J Respir Crit Care Med 2007; 176: 1079-83.