Morales-Martínez E, Magdaleno-Maldonado GE, Pineda-Gudiño RD

Language: Spanish
References: 15
Page: 51-57
PDF size: 236.61 Kb.

ABSTRACT

Introduction: Lower respiratory tract infections remain the most lethal transmissible disease and is the fourth cause of death worldwide. Ventilator associated pneumonia (VAP) occurs in 9 to 25% of patients in the intensive care unit. This study examines the utility of bronchial lavage during bronchoscopy-guided percutaneous tracheostomy in the management of respiratory infections due to multidrug resistant organisms (MRO) in our center. Material and methods: All patients who underwent bronchoscopy-guided percutaneous tracheostomy from September 1, 2015 to September 1, 2017 were included in this retrospective study. Bacterial culture, smears and stain results were obtained along with therapeutic modifications based on the bronchial lavage. Results: Of the 101 percutaneous tracheostomy performed 81 patients were included (56% male, 44% female); mean age, 54.6 years. 42 (51.8%) had positive culture (mono or polybacterial), of this 26 were MDR and related to greater mortality (overall mortality 50%) and hospital stay. In those with VAP Acinetobacter baumannii was isolated in 15 patients. Patients 80 years and older and with Pseudomona aeruginosa had the highest mortality (66.6% and 75%, respectively). Incidence of VAP and tracheobronchitis were 10.45 and 4.36 per 1,000 ventilator days, respectively. In patients with treatment modification mortality was reduced in 54.2%. Bronchoscopy-guided percutaneous tracheostomy prevalence was 13.6% in our center. Conclusions: Bronchial lavage is not routinely performed during bronchoscopy-guided percutaneous tracheostomy. Allows MRO organisms isolation in 51% of the patients. Treatment modification improves mortality.

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