Prevalência e prognóstico dos pacientes com pneumonia associada à ventilação mecânica em um hospital universitário

Abstract

Objective: To determine the prevalence of ventilator-associated pneumonia in an intensive care unit, as well as to identify related factors and characterize patient evolution. Methods: This study evaluated 278 patients on mechanical ventilation for more than 24 hours in a university hospital. Results: Ventilator-associated pneumonia developed in 38.1% of the patients, translating to 35.7 cases/1000 ventilator-days: 45.3% were caused by gram-negative agents (Pseudomonas aeruginosa accounting for 22%); and multidrug resistant organisms were identified in 43.4%. In the ventilator-associated pneumonia group, time on mechanical ventilation, time to mechanical ventilation weaning, hospital stays and intensive care unit stays were all longer (p < 0.001). In addition, atelectasis, acute respiratory distress syndrome, pneumothorax, sinusitis, tracheobronchitis and infection with multidrug resistant organisms were more common in the ventilator-associated pneumonia group (p < 0.05). Mortality rates in the intensive care unit were comparable to those observed in the hospital infirmary. Associations between ventilator-associated pneumonia and various factors are expressed as odds ratios and 95% confidence intervals: acute sinusitis (38.8; 3.4-441); > 10 days on mechanical ventilation (7.7; 4.1-14.2); immunosuppression (4.3; 1.3-14.3); acute respiratory distress syndrome (3.5; 1.4-9.0); atelectasis (3.0; 1.2-7.3); cardiac arrest (0.18; 0.05-0.66); and upper gastrointestinal tract bleeding (0.07; 0.009-0.62). The variables found to be associated with in-hospital death were as follows: chronic renal failure (26.1; 1.9-350.7); previous intensive care unit admission (15.6; 1.6-152.0); simplified acute physiologic score II > 50 (11.9; 3.4-42.0); and age > 55 years (4.4; 1.6-12.3). Conclusion: Ventilator-associated pneumonia increased the time on mechanical ventilation and the number of complications, as well as the length of intensive care unit and hospital stays, but did not affect mortality rates.

Infecção hospitalar: estudo de prevalência em um hospital público de ensino

“…Segundo dados epidemiológicos, 35% a 45% de todos os casos de infecções hospitalares adquiridas, são infecções do trato urinário, sendo que 80% estão relacionadas ao uso de cateter vesical de demora (principal veiculo de transmissão) (9) .…”

“…A vancomicina é um glicopeptídeo, atualmente em uso clínico, que tem seu uso restrito ao tratamento das infecções por gram-positivos (9) . Porém, Rev Bras Enferm, Brasília 2007 jul-ago; 60(4):416-21. nos últimos anos, o aumento das infecções por patógenos gram-positivos foram destaque em diferentes publicações (14) .…”

Pneumonia associada à ventilação mecânica

“…Logistic regression indicated that the factors associated with the development of VAP were acute sinusitis, atelectasis, immunodepression, acute respiratory distress syndrome and being on mechanical ventilation for more than 10 days. (7) The data provided by this study make it possible for an ICU team of attending physicians to recognize the infectious agents that are most often found in their ICU. Therefore, the nosocomial infection control committees of every health care facility should periodically inform their respective ICU heads of the antimicrobial sensitivity profile of the micro-organisms that are most frequently found in their ICUs, since it is known that prompt treatment with appropriate antibiotics is associated with greater treatment success (lower mortality rates) in patients with VAP.…”

“…Based on the results of such studies, interventions can be devised in order to decrease the frequency of this type of nosocomial infection, which, in this study (7) was 35.7 cases/1000 days on mechanical ventilation. This rate is much higher than those recently found in North-American hospitals.…”

“…Their study was aimed at determining VAP prevalence in patients submitted to mechanical ventilation for more than 24 h. It also aimed to identify the factors associated with VAP development and its inhospital prognosis. (7) Over an 18-month period, 808 patients were admitted to the hospital. Of those, 278 were included in the study.…”