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Infectii respiratorii asociate ventilatiei noninvazive

Infectii respiratorii asociate ventilatiei noninvazive. Gianina Rusu Traian Mihaescu. Aparitia infectiilor respiratorii la pacientii ce necesita asistarea ventilatiei este o cauza majora de morbiditate si mortalitate.

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Infectii respiratorii asociate ventilatiei noninvazive

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  1. Infectii respiratorii asociate ventilatiei noninvazive Gianina Rusu Traian Mihaescu

  2. Aparitia infectiilor respiratorii la pacientii ce necesita asistarea ventilatiei este o cauza majora de morbiditate si mortalitate.

  3. Exista o relatie directa intre infectiile nosocomiale si utilizarea instrumentelor invazive (tub endotraheal, cateter venos central, cateter urinar, etc); • …relatia e dependenta de timpul de utilizare

  4. Mentinerea barierelor naturale furnizate de glota si tractul respiraor superior • Reducerea timpului de asistare mecanica, reducerea sedarii, evitarea intubatiei, scaderea timpului petrecut in unitatea de terapie intensiva

  5. Ventilatia noninvaziva (VNI) poate reduce rata de intubatie si mortalitatea la pacientii cu insuficienta respiratorie acuta/cronica si la cei cu edem pulmonar cardiogen. • Antonelli M et al. N Engl J Med 1988; 339: 429-35

  6. 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

  7. 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

  8. Colonizarea sau infectia cailor aeriene cu microoorgaqbisme potential patogene este crescuta la pacientii cu BPOC sever exacerbat si potentata de: • Azotemie/Acidoza • Antibioterapie, clearence deficitar al sputei, terapie inhalatorie • Comorbiditati: boli cerebrovasculare, insuficienta cardiaca congestiva, dementa, diabet zaharat

  9. Colonizarea gastrica creste cu • Virsta • Aclorhidrie • Boli gastrointestinale asociate • Malnutritie • Tratament cu antiacide sau blocanti tip 2 histamina

  10. Colonizarea cu bacili Gram negativi, in special Pseudomonas aeruginosa, este asociata semnificativ cu esecul VNI • Ferrer M et al. Crit Care Med 2001; 164: 1231-35

  11. Risc de infectie • Staphylococcus aureus meticillino rezistent • Psudomonas aeruginosa • Enterobacteria • Acinetotobacter spp

  12. Atentie! • Riscul e diferit la: • Exacerbari acute din BPOC • Edem pulmonar cardiogen • Pacienti imunocompromisi

  13. Terapia empirica • Cunoasterea speciilor bacteriene posibil responsabile • Epidemiologia locala – ghid pe spital • Severitatea bolii • Spectrul bolnavilor tratati (medical, chirurgical, post ICU) • Statusul functional al pacientilor • Expunerea anterioara la antibiotice

  14. “Hit hard and hit fast”!

  15. “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

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