Lavado broncoalveolar en el diagnóstico etiológico de las neumonías adquiridas por ventilación mecánica - Hospital Luis Vernaza 2015-2016
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2017
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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La neumonía asociada a ventilación mecánica (NAVM) es la principal complicación nosocomial con altas tasas de morbi-mortalidad. El objetivo principal del trabajo fue conocer la utilidad del lavado broncoalveolar (BAL) en el diagnóstico etiológico de la neumonía asociada a ventilación mecánica en el Hospital Luis Vernaza. El estudio fue observacional descriptivo retrospectivo, analítico; el universo lo constituyeron todos los pacientes ingresados a UCI, desde Enero del 2015 hasta Marzo del 2016; con diagnóstico de Neumonía asociado a ventilación mecánica. Los resultados obtenidos fueron: Un total de 71 pacientes; 52 pacientes fueron hombres (73.2%) y 19 mujeres (26,8%). La edad de presentación fue >65 años (36.6%); 10 casos presentaron Neumonía por ventilación tipo temprana (14.1%) y 61 casos tipo tardía (85.9%). El lavado broncoalveolar fue positivo (10.000 ufc/ml) en 52 pacientes (73.2%); de los cuales 6 con NAVM temprana (11.5%) y 46 con NAVM tardía (88.5%); los germen causales encontrados fueron Acinetobacter baumannii 34.6%, seguido por Pseudomona aeuroginosa y Klebsiella Pneumoniae ambas con 21.2%. Hubieron 68 pacientes que recibieron antibióticos antes de la realización del BAL (95.8%), 51 de ellos tuvieron BAL positivo (75%). La mortalidad de la NAVM fue de 47.9% (34 pacientes); 19 de ellos eran mayor de 65 años (55.9%), y 30 tenían diagnóstico de NAVM tardía (88.2%). En conclusión el BAL tiene una alta rentabilidad diagnóstica (73%) y no parece estar influenciado por el uso previo de antibióticos ni por el tipo de neumonía.
Ventilator-Associated Pneumonia is one of the main hospital complications this produces high rates of morbidity and mortality. The target of our study was to determine the utility of bronchoalveolar lavage in the etiologic diagnosis of Ventilator-Associated Pneumonia in the intensive care unit of Luis Vernaza Hospital. The study was descriptive retrospective that covered the period from 1 January 2015 until 31 March 2016 with diagnosis of Ventilator-Associated Pneumonia. The results were: a total of 71 patients; 59 patients were men (83.1%) and 12 were women (16.9%). The most frequent age of presentation was> 65 years (36.6%); 10 cases had early VAP (14.1%) and 61 cases of late– onset VAP (85.9%) they had than 5 days on mechanical ventilation. Bronchoalveolar lavage was positive (10,000 cfu / ml) in 52 patients (73.2%); of which 6 with early-onset VAP (11.5%) and 46 with late-onset VAP (88.5%); the most common causative organism was found Acinetobacter baumannii 34.6%, followed by Pseudomonas aeruginosa and Klebsiella pneumoniae both with 21.2%. There were 68 patients who received antibiotics before performing BAL (95.8%), 51 of them had positive BAL (75%). Mortality was 47.9% (34 cases); 19 of them were older than 65 (55.9%), and 30 had a diagnosis of late-onset VAP (88.2%). In conclusion, the BAL has a high diagnostic yield (73%) and does not appear to be influenced by the previous use of antibiotics nor by the type of pneumonia
Ventilator-Associated Pneumonia is one of the main hospital complications this produces high rates of morbidity and mortality. The target of our study was to determine the utility of bronchoalveolar lavage in the etiologic diagnosis of Ventilator-Associated Pneumonia in the intensive care unit of Luis Vernaza Hospital. The study was descriptive retrospective that covered the period from 1 January 2015 until 31 March 2016 with diagnosis of Ventilator-Associated Pneumonia. The results were: a total of 71 patients; 59 patients were men (83.1%) and 12 were women (16.9%). The most frequent age of presentation was> 65 years (36.6%); 10 cases had early VAP (14.1%) and 61 cases of late– onset VAP (85.9%) they had than 5 days on mechanical ventilation. Bronchoalveolar lavage was positive (10,000 cfu / ml) in 52 patients (73.2%); of which 6 with early-onset VAP (11.5%) and 46 with late-onset VAP (88.5%); the most common causative organism was found Acinetobacter baumannii 34.6%, followed by Pseudomonas aeruginosa and Klebsiella pneumoniae both with 21.2%. There were 68 patients who received antibiotics before performing BAL (95.8%), 51 of them had positive BAL (75%). Mortality was 47.9% (34 cases); 19 of them were older than 65 (55.9%), and 30 had a diagnosis of late-onset VAP (88.2%). In conclusion, the BAL has a high diagnostic yield (73%) and does not appear to be influenced by the previous use of antibiotics nor by the type of pneumonia
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Neumonía, Respiración artificial, Diagnóstico, Etiología, Lavado broncoalveolar, Epidemiología analítica, Epidemiología descriptiva, Estudios retrospectivos, Cantón Guayaquil, Ecuador, Hospital Luis Vernaza