Gianina Rusu

Traian Mihaescu
Aparitia infectiilor respiratorii
la pacientii ce necesita
asistarea ventilatiei este o
cauza majora de morbiditate
si mortalitate.
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
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
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
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
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
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
Virsta
Aclorhidrie
Boli gastrointestinale asociate
Malnutritie
Tratament cu antiacide sau blocanti tip 2
histamina
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
Staphylococcus aureus meticillino
rezistent
Psudomonas aeruginosa
Enterobacteria
Acinetotobacter spp

Riscul e diferit la:

Exacerbari acute din BPOC
Edem pulmonar cardiogen
Pacienti imunocompromisi
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


Hit hard and hit fast!




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