Diretrizes brasileiras para tratamento das pneumonias adquiridas no hospital e das associadas à ventilação mecânica - 2007

doi:10.1590/s1806-37132007000700001

Cited by 18 publications

(5 citation statements)

References 107 publications

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“…Respiratory infection was defined, in accordance with clinical criteria, 26 as an association of hyperthermia, infectious leukogram and compatible radiological examination. Surgical wound infections were diagnosed from occurrences of local phlogistic signs such as heat, redness, pain, purulent secretion and edema, along with the presence of sternum instability, fever and an infectious leukogram.…”

Section: Methodsmentioning

confidence: 99%

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Left lateral intercostal region versus subxiphoid position for pleural drain during elective coronary artery bypass graft surgery: randomized clinical trial

et al. 2019

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INTRODUCTION Coronary artery bypass graft (CABG) surgery is associated with higher survival rates and better quality of life among patients with coronary artery disease. 1,2 Use of left internal thoracic artery (LITA) grafts has been correlated with long-term benefits, 3 but this often requires pleurotomy and insertion of tubes to drain the cavity. 4,5 Pleural drains can be inserted into the subxiphoid region or the intercostal space with the main objective of maintaining or restoring the negative pressure of the pleural space. 6 However, they may impair the integrity of the ventilatory system, thereby compromising the respiratory mechanics and gas exchange after surgery. 7-9 Respiratory muscle strength may be evaluated through maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), which indicate the strength of the inspiratory and expiratory muscle groups respectively. 10 Predictions for MIP and MEP according to age and sex should preferably be considered within their clinical setting, because they may lead to a prognosis of postoperative pulmonary complications like respiratory muscle fatigue or failure. 11-13 MIP and MEP can be measured with the aid of a manometer or manovacuometer. In addition to being practical and non-invasive, this equipment has low cost, is easy to apply at the bedside and only requires simple inspiration and expiration movements from the patient. Studies on individuals undergoing CABG surgery have shown that insertion of the pleural drain in the subxiphoid position can minimize the chance of trauma to the thoracic wall, may preserve respiratory function in the immediate postoperative period and may lead to lower levels of subjective pain, compared with lateral intercostal insertion. 14-20 However, most of these studies

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Section: Methodsmentioning

confidence: 99%

“…Surgical wound infections were diagnosed from occurrences of local phlogistic signs such as heat, redness, pain, purulent secretion and edema, along with the presence of sternum instability, fever and an infectious leukogram. 26 , 27 , 28 , 29 …”

Section: Methodsmentioning

confidence: 99%

Left lateral intercostal region versus subxiphoid position for pleural drain during elective coronary artery bypass graft surgery: randomized clinical trial

et al. 2019

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“…Alguns exemplos de fatores de risco não modificáveis são: idade, gravidade da doença de base, Doença Pulmonar Obstrutiva Crônica (DPOC), traumas e cirurgias (26) . Os métodos de prevenção da PAVM se dão por meio da atuação dos fatores modificáveis, através de simples medidas preventivas adotadas pela equipe multiprofissional de saúde, dentre os exemplos de fatores de riscos modificáveis estão: as ações de educação permanente dos profissionais sobre os fatores de risco, importância da higiene oral, o estabelecimento de protocolos que evitem o uso indiscriminado de antibióticos, a correta lavagem das mãos, formulação de protocolos de desmame ventilatório e sedação bem como remoção precoce dos dispositivos invasivos que podem servir como porta de entrada para os microrganismos causando as infecções nosocomiais (26) . Portanto, observa-se que os fatores de risco modificáveis são de suma importância na tomada de decisões para o tratamento e prevenção da PAVM, pois retratam as circunstâncias que podem sofrer intervenções diretas da equipe multiprofissional de saúde e com isso, podendo alterar a sua epidemiologia (3) .…”

Section: Fatores De Risco E Métodos De Prevenção Da Pavmunclassified

Os Principais Fatores De Risco Da Pneumonia Associada À Ventilação Mecânica Em Uti Adulta.

Costa¹,

Costa

Torres³

et al. 2016

Rev Cient Fac Educ e Meio Ambient

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A pneumonia é uma inflamação do parênquima pulmonar causada por diversos agentes etiológicos, as pneumonias hospitalares são causadas principalmente por Enterobacter, Escherichia coli, Klebsiella, Proteus, Serratia marcescens, Pseudomonas aeruginosa e Staphylococcus aureus. A pneumonia associada à ventilação mecânica (PAVM) é considerada a infecção nosocomial mais frequente em unidades de terapia intensiva (UTI) e é definida como uma inflamação do parênquima pulmonar, que aparece após 48 a 72 horas da intubação endotraqueal e do inicio da ventilação mecânica. O objetivo desse trabalho foi demonstrar os principais fatores de risco para a aquisição da PAVM. A pesquisa de revisão literária se deu através de base de dados, como PubMed e Bireme, LILACS, SciELO, o período de publicação compreenderam os anos de 1998 á 2013. A PAVM possui alguns fatores de risco, que são classificados em modificáveis ou não modificáveis. Alguns exemplos desses fatores de risco não modificáveis são: idade, gravidade da doença de base, Doença Pulmonar Obstrutiva Crônica (DPOC). E os fatores modificáveis alguns exemplos são: educação continuada dos profissionais sobre os fatores de risco, o estabelecimento de protocolos que evitem o uso indiscriminado de antibióticos. Conclui-se através dessa revisão literária que a maioria dos pacientes internados em UTI está em ventilação mecânica (VM) e que nos pacientes intubados, a incidência de pneumonia é de 7 a 21 vezes mais elevado em relação àqueles que não necessitam de ventiladores e por isso são necessárias medidas preventivas.

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“…The mortality rate of hospital-associated infections, such as those of the urinary tract and skin, can vary from 1 to 4%; and yet, mortality rate of VAP amounts to over 70% [3]. Concomitantly,~10 to 20% of mechanically ventilated patients develop VAP worldwide [6,7] and this incidence ranges from 6 to 52% in Brazil [8].…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, the cost of treating patients with VAP is higher than that of patients without the disease, which contributes to significantly increase hospital costs [9]. One of the causes for the development of VAP is the presence of microaspirations of secretion above the cuff [5,6,[11][12][13], i.e., a favorable site for colonization and infection of microorganisms, including bacteria, which can reach the lower airways [2,5,[12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Indicative Factors for 48 or More Hours of Mechanical Ventilation to Optimize the Use of Orotracheal Tubes with Supra-cuff Suction Devices: a Retrospective Study

Creace

Marson

Cannonieri-Nonose

2021

SN Compr. Clin. Med.

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The objective of this study is to verify the risk factors for invasive mechanical ventilation (IMV) for ≥48h, aiming at the best indication of orotracheal tubes (OTTs) with supra-cuff suction devices. This retrospective and observational study was carried out at the Adult Intensive Care Unit of the University Hospital during a 2-year period. Patients undergoing orotracheal intubation were enrolled. Demographic and clinical data were collected from medical records. A total of 1185 medical records were analyzed, of which 820 were included in the study. The markers associated with intubation for ≥48h were as follows: positive history of diseases (RR=1.42; 95%CI=1.17 to 1.74), especially alcohol addiction (RR=1.60; 95%CI=1.22 to 2.09) or former alcohol addiction (RR=1.50; 95%CI=1.06 to 2.13); clinical hospitalization (RR=1.06; 95%CI=0.98 to 1.16); emergency intubation (RR=3.24; 95%CI=3.01 to 3.95); intubation performed in the emergency department (RR=3.44; 95%CI=3.01 to 3.95) and other hospital facilities (RR=2.92; 95%CI=2.49 to 3.42); and intubation due to lowered level of consciousness (RR=3.40; 95%CI=2.95 to 3.93), acute respiratory failure (RR=3.43; 95%CI=2.98 to 3.54), and airway protection (RR=2.87; 95%CI=2.32 to 3.54). Patients on IMV for ≥48h had an RR of 2.07 (95%CI=1.79 to 2.40) for death. Patients with history of diseases, especially past or current history of alcoholism with clinical hospitalization, who underwent emergency intubation in the emergency department or in other hospital facilities due to lowered level of consciousness, acute respiratory failure, or protect airways, are most likely to require IMV for ≥48h. Also, patients on IMV for ≥48h had an high RR for death.

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Diretrizes brasileiras para tratamento das pneumonias adquiridas no hospital e das associadas à ventilação mecânica - 2007

Cited by 18 publications

References 107 publications

Left lateral intercostal region versus subxiphoid position for pleural drain during elective coronary artery bypass graft surgery: randomized clinical trial

Left lateral intercostal region versus subxiphoid position for pleural drain during elective coronary artery bypass graft surgery: randomized clinical trial

Os Principais Fatores De Risco Da Pneumonia Associada À Ventilação Mecânica Em Uti Adulta.

Indicative Factors for 48 or More Hours of Mechanical Ventilation to Optimize the Use of Orotracheal Tubes with Supra-cuff Suction Devices: a Retrospective Study

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