Infectii respiratorii asociate ventilatiei noninvazive
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Infectii respiratorii Infectii respiratorii asociate ventilatiei asociate ventilatiei noninvazivenoninvazive
Gianina RusuGianina Rusu
Traian MihaescuTraian Mihaescu
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Aparitia infectiilor respiratorii Aparitia infectiilor respiratorii la pacientii ce necesita la pacientii ce necesita asistarea ventilatiei este o asistarea ventilatiei este o cauza majora de morbiditate cauza majora de morbiditate si mortalitate.si mortalitate.
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Exista o relatie directa intre Exista o relatie directa intre infectiile nosocomiale si infectiile nosocomiale si utilizarea instrumentelor invazive utilizarea instrumentelor invazive (tub endotraheal, cateter venos (tub endotraheal, cateter venos central, cateter urinar, etc); central, cateter urinar, etc);
……relatia e dependenta de timpul relatia e dependenta de timpul de utilizarede utilizare
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Mentinerea barierelor naturale furnizate Mentinerea barierelor naturale furnizate de glota si tractul respiraor superiorde glota si tractul respiraor superior
Reducerea timpului de asistare Reducerea timpului de asistare
mecanica, reducerea sedarii, evitarea mecanica, reducerea sedarii, evitarea intubatiei, scaderea timpului petrecut in intubatiei, scaderea timpului petrecut in unitatea de terapie intensivaunitatea de terapie intensiva
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Ventilatia noninvaziva (VNI) Ventilatia noninvaziva (VNI) poate reduce rata de intubatie poate reduce rata de intubatie si mortalitatea la pacientii cu si mortalitatea la pacientii cu insuficienta respiratorie insuficienta respiratorie acuta/cronica si la cei cu acuta/cronica si la cei cu edem pulmonar cardiogen.edem pulmonar cardiogen.
Antonelli M et al. N Engl J Med 1988; 339: 429-35Antonelli M et al. N Engl J Med 1988; 339: 429-35
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In patients with acute respiratory failure, noninvasive ventilation was as effective as conventional ventilation in improving gas exchange and was associated with fewer serious complications and shorter stays in the intensive care unit.
N Engl J Med 1998;339:429-35
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Use of NIV instead of mechanical ventilation is associated with a lower risk of nosocomial infections, less antibiotic use, shorter length of ICU stay, and lowermortality.
JAMA. 2000;284:2361-2367
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Colonizarea sau infectia cailor aeriene cu Colonizarea sau infectia cailor aeriene cu microoorgaqbisme potential patogene este microoorgaqbisme potential patogene este crescuta la pacientii cu BPOC sever exacerbat crescuta la pacientii cu BPOC sever exacerbat si potentata de:si potentata de:
Azotemie/AcidozaAzotemie/Acidoza Antibioterapie, clearence deficitar al sputei, Antibioterapie, clearence deficitar al sputei,
terapie inhalatorieterapie inhalatorie Comorbiditati: boli cerebrovasculare, Comorbiditati: boli cerebrovasculare,
insuficienta cardiaca congestiva, dementa, insuficienta cardiaca congestiva, dementa, diabet zaharatdiabet zaharat
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Colonizarea gastrica Colonizarea gastrica creste cucreste cu
VirstaVirsta AclorhidrieAclorhidrie Boli gastrointestinale asociateBoli gastrointestinale asociate MalnutritieMalnutritie Tratament cu antiacide sau blocanti tip 2 Tratament cu antiacide sau blocanti tip 2
histaminahistamina
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Colonizarea cu bacili Gram negativi, in Colonizarea cu bacili Gram negativi, in special special Pseudomonas aeruginosaPseudomonas aeruginosa, este , este asociata semnificativ cu esecul VNIasociata semnificativ cu esecul VNI
Ferrer M et al. Ferrer M et al. Crit Care MedCrit Care Med 2001; 164: 1231-35 2001; 164: 1231-35
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Risc de infectieRisc de infectie
Staphylococcus aureusStaphylococcus aureus meticillino meticillino rezistentrezistent
Psudomonas aeruginosaPsudomonas aeruginosa EnterobacteriaEnterobacteria AcinetotobacterAcinetotobacter spp spp
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Atentie!Atentie!
Riscul e diferit la:Riscul e diferit la:
Exacerbari acute din BPOCExacerbari acute din BPOC Edem pulmonar cardiogenEdem pulmonar cardiogen Pacienti imunocompromisiPacienti imunocompromisi
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Terapia empiricaTerapia empirica
Cunoasterea speciilor bacteriene posibil Cunoasterea speciilor bacteriene posibil responsabileresponsabile
Epidemiologia locala – ghid pe spitalEpidemiologia locala – ghid pe spital Severitatea boliiSeveritatea bolii Spectrul bolnavilor tratati (medical, Spectrul bolnavilor tratati (medical,
chirurgical, post ICU)chirurgical, post ICU) Statusul functional al pacientilorStatusul functional al pacientilor Expunerea anterioara la antibioticeExpunerea anterioara la antibiotice
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““Hit hard and hit fast”!Hit hard and hit fast”!
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“Health-care workers should take adequate precautions when providing NPPV support to patients with pneumonia of unknown etiology complicated by respiratory failure!”
Hui DS et al. Chest 2009; 136: 998-1005