RESUMO
INTRODUÇÃO: In Intensive Care Units, oral hygiene is a care action directly related to the safety and well-being of the patient, being one of the main ways of preventing Pneumonia Associated with Mechanical Ventilation. Although relevant, the recommendations and standardization on oral hygiene among critically ill patients are diffuse. OBJECTIVE: To construct and validate a standard operating procedure (SOP) for oral hygiene performed by the nursing team for intubated and tracheostomized patients in an Intensive Care Unit (ICU). METHODS: Methodological study developed in five stages: technical-scientific support; construction of SOP; recruitment and selection of experts; validation and presentation of the final version. The SOP was subjected to validation by judges with academic and/or clinical expertise (n=13) from all regions of Brazil, who assessed the validity criteria for each SOP item: Scope, Clarity, Coherence, Criticism, Objectivity, Scientific writing; Relevance, Sequence, and Uniqueness. The Content Validity Indices (CVI) of each validity criterion, SOP item, and the general CVI were calculated. RESULTS: The experts were nurses (38.5%), dentists (38.5%), doctors (15.4%) and physiotherapists (7.7%). None of the SOP items had a CVI lower than 0.80. The general CVI was 0.95 and the experts' suggestions were mostly accepted (78.6%). The final version is available as an infographic, which illustrates the stages of the oral hygiene process of the intubated and tracheostomized patient. CONCLUSION: The constructed SOP has a satisfactory face and content validity, making a final total of 43 items to be used for oral hygiene of intubated and tracheostomy patients.
INTRODUÇÃO: Em Unidades de Terapia Intensiva, a higienização bucal é ação de cuidado diretamente relacionada à segurança do paciente e qualidade do cuidado, sendo uma das principais formas de prevenção da Pneumonia Associada à Ventilação Mecânica. Apesar disso, as recomendações e a padronização sobre a higienização bucal entre pacientes críticos são difusas. OBJETIVO: Construir e validar um procedimento operacional padrão (POP) para higiene bucal realizada pela enfermagem a pacientes intubados e traqueostomizados em Unidade de Terapia Intensiva (UTI). MÉTODOS: Estudo metodológico desenvolvido em cinco etapas: subsídio técnico-científico; construção do POP; recrutamento e seleção de experts; validação de face e conteúdo do POP e apresentação da versão final. O POP foi submetido à validação por juízes com expertise acadêmica e/ou clínica (n=13) de todas as regiões do Brasil, os quais apreciaram os critérios de validade: Abrangência, Clareza, Coerência, Criticidade, Objetividade, Redação científica; Relevância, Sequência e Unicidade. Foram calculados os Índices de Validade de Conteúdo (IVC) de cada critério, item do POP e o IVC geral. RESULTADOS: Os experts eram enfermeiros(as) (38,5%), cirurgiãs-dentistas (38,5%), médicos(as) (15,4%) e fisioterapeuta (7,7%). Nenhum item do POP obteve IVC inferior a 0,80. O IVC geral foi de 0,95 e sugestões dos experts foram majoritariamente acatadas (78,6%). A versão final, disponível como infográfico, contempla ilustrativamente as etapas do processo de higienização bucal do paciente intubado e traqueostomizado. CONCLUSÃO: O POP alcançou validade de face e conteúdo satisfatória. A versão validada possui 43 itens processuais para higiene bucal de pacientes intubados e traqueoestomizados.
Assuntos
Humanos , Masculino , Feminino , Adulto , Higiene Bucal , Traqueostomia , Protocolos Clínicos , Pneumonia Associada à Ventilação Mecânica/terapia , Unidades de Terapia Intensiva , Intubação , Segurança do PacienteRESUMO
Introducción: La neumonía asociada a la ventilación mecánica es una infección, que se relaciona con los cuidados sanitarios. Objetivo: Caracterizar clínica y epidemiológicamente a niños y adolescentes con neumonía asociada a la ventilación mecánica, según variables seleccionadas. Método: Se realizó un estudio descriptivo y transversal de 36 pacientes con neumonía asociada a la ventilación mecánica, ingresados en la Unidad de Cuidados Intensivos del Hospital Infantil Norte Dr. Juan de la Cruz Martínez Maceira de Santiago de Cuba, desde enero del 2017 hasta diciembre del 2018. Resultados: Se halló un predominio de los pacientes menores de 5 años de edad (80,6 %), del sexo masculino (66,7 %), la ventilación mecánica prolongada (69,4 %) y las neumonías asociadas a la ventilación de aparición tardía relacionadas con la mortalidad. Los microorganismos más frecuentes resultaron ser los gramnegativos. La combinación de cefalosporinas y vancomicina fue la más utilizada. Conclusiones: La evolución de los pacientes dependió del tiempo de inicio, el microorganismo predominante y el tratamiento antimicrobiano empleado.
Introduction: The pneumonia associated with the mechanical ventilation is an infection that is related to the sanitary cares. Objective: To characterize clinical and epidemiologically children and adolescents with pneumonia associated with the mechanical ventilation, according to selected variables. Method: A descriptive and cross-sectional study of 36 patients with pneumonia associated with mechanical ventilation admitted in the Intensive Cares Unit of Dr. Juan de la Cruz Martínez Maceira Northern Children Hospital; was carried out in Santiago de Cuba, from January, 2017 to December, 2018. Results: There was a prevalence of the patients under 5 years (80.6 %), the male sex (66.7 %), the long lasting mechanical ventilation (69.4 %) and pneumonias associated with the ventilation of late appearance related to mortality. The most frequent microorganisms were the Gram negative. The combination of cephalosporins and vancomycin were the most used. Conclusions: The clinical course of the patients depended on the time of beginning, the predominant microorganism and the antimicrobial treatment used.
Assuntos
Pneumonia Associada à Ventilação Mecânica/terapia , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Respiração Artificial/efeitos adversos , Pré-Escolar , AdolescenteRESUMO
Intensive care unit-acquired bloodstream infections (ICU-BSI) are frequent and are associated with high morbidity and mortality rates. We conducted this study to describe the epidemiology and the prognosis of ICU-BSI in our ICU and to search for factors associated with mortality at 28 days. For this, we retrospectively studied ICU-BSI in the ICU of the Cayenne General Hospital, from January 2013 to June 2019. Intensive care unit-acquired bloodstream infections were diagnosed in 9.5% of admissions (10.3 ICU-BSI/1,000 days). The median delay to the first ICU-BSI was 9 days. The ICU-BSI was primitive in 44% of cases and secondary to ventilator-acquired pneumonia in 25% of cases. The main isolated microorganisms were Enterobacteriaceae in 67.7% of patients. They were extended-spectrum beta-lactamase (ESBL) producers in 27.6% of cases. Initial antibiotic therapy was appropriate in 65.1% of cases. Factors independently associated with ESBL-producing Enterobacteriaceae (ESBL-PE) as the causative microorganism of ICU-BSI were ESBL-PE carriage before ICU-BSI (odds ratio [OR]: 7.273; 95% CI: 2.876-18.392; P < 0.000) and prior exposure to fluoroquinolones (OR: 4.327; 95% CI: 1.120-16.728; P = 0.034). The sensitivity of ESBL-PE carriage to predict ESBL-PE as the causative microorganism of ICU-BSI was 64.9% and specificity was 81.2%. Mortality at 28 days was 20.6% in the general population. Factors independently associated with mortality at day 28 from the occurrence of ICU-BSI were traumatic category of admission (OR: 0.346; 95% CI: 0.134-0.894; P = 0.028) and septic shock on the day of ICU-BSI (OR: 3.317; 95% CI: 1.561-7.050; P = 0.002). Mortality rate was independent of the causative organism.
Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla , Adulto , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Bacteriemia/terapia , Candidemia/epidemiologia , Candidemia/mortalidade , Candidemia/terapia , Portador Sadio/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/mortalidade , Infecções Relacionadas a Cateter/terapia , Cateterismo Venoso Central/estatística & dados numéricos , Cateterismo Periférico/estatística & dados numéricos , Coma/epidemiologia , Comorbidade , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Infecção Hospitalar/terapia , Infecções por Enterobacteriaceae/epidemiologia , Feminino , Guiana Francesa/epidemiologia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/terapia , Prognóstico , Terapia de Substituição Renal/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Insuficiência Respiratória/epidemiologia , Estudos Retrospectivos , Choque/epidemiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Infecções Estafilocócicas/terapia , Ferimentos e Lesões/epidemiologiaRESUMO
Brindar recomendaciones basadas en evidencia para el manejo de la neumonía Intrahospitalaria y neumonía asociada a ventilador mecánico.
Assuntos
Humanos , Adulto , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Antibacterianos/uso terapêutico , Combinação de Medicamentos , Pneumonia Associada à Ventilação Mecânica/diagnóstico , Pneumonia Associada à Ventilação Mecânica/terapia , Gestão de AntimicrobianosAssuntos
Gestão de Antimicrobianos , Fidelidade a Diretrizes , Microscopia/estatística & dados numéricos , Pneumonia Associada à Ventilação Mecânica/diagnóstico , Brasil , Humanos , Unidades de Terapia Intensiva , Pneumonia Associada à Ventilação Mecânica/terapia , Estudos Prospectivos , Respiração Artificial/efeitos adversos , Traqueia/microbiologiaRESUMO
BACKGROUND: Pulmonary edema may alter alveolar bacterial clearance and infectivity. Manipulation of fluid balance aimed at reducing fluid overload may, therefore, influence ventilator-associated pneumonia (VAP) occurrence in intubated patients. The objective of the present study was to assess the impact of a depletive fluid-management strategy on ventilator-associated complication (VAC) and VAP occurrence during weaning from mechanical ventilation. METHODS: We used data from the B-type Natriuretic Peptide for the Fluid Management of Weaning (BMW) randomized controlled trial performed in nine ICUs across Europe and America. We compared the cumulative incidence of VAC and VAP between the biomarker-driven, depletive fluid-management group and the usual-care group during the 14 days following randomization, using specific competing-risk methods (the Fine and Gray model). RESULTS: Among the 304 patients analyzed, 41 experienced VAP, including 27 (17.8%) in the usual-care group vs 14 (9.2%) in the interventional group (P = .03). From the Fine and Gray model, the probabilities of VAC and VAP occurrence were both significantly reduced with the interventional strategy while adjusting for weaning outcome as a competing event (subhazard ratios [25th-75th percentiles], 0.44 [0.22-0.87], P = .02 and 0.50 [0.25-0.96], P = .03, respectively). CONCLUSIONS: Using proper competing risk analyses, we found that a depletive fluid-management strategy, when initiating the weaning process, has the potential for lowering VAP risk in patients who are mechanically ventilated. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00473148; URL: www.clinicaltrials.gov.
Assuntos
Diuréticos/uso terapêutico , Hidratação/métodos , Pneumonia Associada à Ventilação Mecânica/etiologia , Respiração Artificial/efeitos adversos , Desmame do Respirador/métodos , Idoso , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/terapia , América do Sul/epidemiologia , Resultado do TratamentoRESUMO
OBJECTIVE: To analyze biofilm on internal and external surfaces of endotracheal tubes after their use in critical care patients, and to produce evidence of association between use of the tube, presence of biofilm, and the occurrence of pneumonia. METHODS: This was a clinical study performed at the Intensive Care Unit of an emergency hospital in the interior of São Paulo state, Brazil. Data collection involved 30 endotracheal tubes used on adult patients for a period of ≥48 h of mechanical ventilation for scanning electron microscopy. RESULTS: Analysis of the biofilm on the 30 tubes by scanning electron microscopy showed various abiotic and biotic structures, predominantly on the internal surface, such as: fibrin network, erythrocytes, leukocytes, cocci, bacilli, and molds, among others. The intubation period of the endotracheal tube for ≥8 days represented one of the risk factors for ventilator-associated pneumonia (RR 7.41, P < 0.001). CONCLUSIONS: The presence of the endotracheal tube permits microbial colonization, overall contributing to the development of biofilm and the occurrence of pneumonia.
Assuntos
Biofilmes , Contaminação de Equipamentos , Intubação Intratraqueal/efeitos adversos , Pneumonia Associada à Ventilação Mecânica/microbiologia , Ventiladores Mecânicos/microbiologia , Bactérias/isolamento & purificação , Bactérias/ultraestrutura , Fenômenos Fisiológicos Bacterianos , Brasil , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Intubação Intratraqueal/instrumentação , Pneumonia Associada à Ventilação Mecânica/etiologia , Pneumonia Associada à Ventilação Mecânica/terapia , Respiração Artificial/efeitos adversosRESUMO
Objetivo: Este estudio estuvo dirigido para conocer el grado de correlación clínica entre tratamiento antibiótico inicial y el resultado cultivos de aspiración bronquial en pacientes con neumonía asociada a ventilación mecánica en la Unidad de Cuidados Intensivos del Hospital Nacional Dos de Mayo. Periodo 2013-2014. Diseño: Se realizó un estudio clínico prospectivo, longitudinal y diseño transversal en pacientes del Hospital 2 de Mayo en el periodo de Octubre 2013-Marzo 2014. Materiales y métodos: Se seleccionaron a todos los pacientes que tuvieron Neumonía asociado a ventilación durante el periodo de estudio. Resultados: Se estudiaron 23 pacientes con una edad media de 64,87 +/- 18.319 años, que varía de 20 a 91 años. El diagnóstico de ingreso más frecuente fue shock séptico con 30.4 por ciento y la mortalidad por NAV fue de 17,4 por ciento, el 100 por ciento inicio tratamiento con ceftazidima+amikacina, la NAV precoz fue evidenciada solo en 11 (47,8 por ciento), NAV tardía en 12 (52,2 por ciento). El germen más frecuente aislado fue Staphylococo aureus con 47,8 por ciento, y acinotebacter baumm con 21,7 por ciento, se cambió de terapéutica en 4 pacientes por Carbapenem el 17,4 por ciento, y en uno de ellos se cambió por colistina 4,3 por ciento. Se presentó disfunción multiorgánica en 3 pacientes 13 por ciento, y falla multiorgánica en 1 4,3 por ciento. Conclusión: Al iniciar una terapéutica antibiótica eficaz fue del 75 por ciento en el periodo de estudio en el Hospital 2 de Mayo, la mortalidad fue del 17,4 por ciento.
Objective: This study was aimed to determine the degree of clinical correlation between initial antibiotic treatment and outcome crops bronchial aspiration in patients with ventilator-associated pneumonia in the Intensive Care Unit of the National Hospital Dos de Mayo. 2013-2014. Design: A prospective, longitudinal and cross-sectional clinical study was conducted on patients from Hospital 2 de Mayo in the period October 2013-March 2014. Materials and methods: All patients who had pneumonia associated with ventilation during the study period were selected. Results: 23 patients were studied with a mean age of 64.87 +/- 18,319 years, ranging from 20 to 91. The most common admission diagnosis was septic shock with 30.4 per cent and the mortality was 17.4 per cent NAV, 100 per cent home treatment with ceftazidime + amikacin, early NAV was evidenced only in 11 (47.8 per cent), late in NAV 12 (52.2 per cent), the most common pathogen isolated was Staphylococcus aureus with 47.8 per cent, and it Baumm acinotebacter with 21.7 per cent, the change of therapy in 4 patients by Carbapenem 17.4 per cent, and in one of they change by colistin 4.3 per cent, multiorgan dysfunction was present in 3 patients, 13 per cent, and multiorgan failure 14.3 per cent. Conclusion: The importance of starting effective antibiotic therapy was 75 per cent in the study period in the Hospital May 2.