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Infeções respiratórias associadas aos cuidados de saúde numa UCIP : casuística de um ano
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As Infeções Associadas aos Cuidados de Saúde (IACS) são infeções documentadas após 48h de internamento numa instituição de saúde e constituem o efeito adverso mais frequente dos internamentos hospitalares. As IACS constituem um problema com importância crescente nas UCI Pediátricas (UCIP), principalmente no caso das IACS respiratórias associadas à ventilação, que são as mais frequentes e contribuem para o aumento da morbi-mortalidade. Sendo a vigilância epidemiológica importante para o controlo e prevenção das IACS, este trabalho teve como objetivo o estudo da casuística da UCIP do Hospital de Santa Maria (UCIPed HSM) no que diz respeito às IACS relacionadas com a utilização de ventilação mecânica, nomeadamente a pneumonia (PAV) e a traqueobronquite (TAV). Foi também efetuada uma revisão tórica sobre o tema. Para a realização deste estudo foram selecionados todos os doentes internados na UCIPed em 2018, que estiveram sob ventilação mecânica invasiva (VMI) ou nãoinvasiva (VNI) durante pelo menos 48 horas. Os casos de PAV e TAV foram identificados de acordo com os critérios definidos pelo Programa HELICS-UCI da Direção Geral de Saúde (DGS). Em 2018, 91 doentes tiveram suporte ventilatório 48 ou mais horas, tendo sido identificados seis casos de IACS respiratórias (cinco com PAV e um com TAV). Três dos doentes apresentavam doenças crónicas, cinco com infeções ativas e todos cumpriam terapêutica antimicrobiana na admissão. A duração média do internamento foi 21,8 dias e estiveram em média 20,5 dias ventilados. Nos doentes com IACS foram identificados fatores de risco intrínsecos e extrínsecos aos doentes. Verificou-se a associação entre o desenvolvimento de PAV e TAV e o maior tempo de internamento e ventilação (p<0.001). É necessária a adequação dos critérios utilizados na vigilância epidemiológica ao contexto pediátrico e que se continue a apostar na prevenção, por forma a melhorar os cuidados de saúde prestados aos doentes sob ventilação mecânica.
Healthcare-associated Infections (HAI) are documented infections after 48 hours of hospital stay and are the most frequent adverse effect of hospital admissions. HAI are an increasingly important problem in pediatric ICU (PICU), especially ventilatory respiratory HAI, which are the most frequent and contribute to increased morbidity and mortality. As epidemiological surveillance is important for the control and prevention of HAI, this work aims to study the HAI related to the use of mechanical ventilation in PICU - Hospital Santa Maria (UCIPed HSM), namely pneumonia (VAP) and tracheobronchitis (VAT). Was also carried out a review on the subject. All patients admitted to the PICU in 2018 who underwent invasive mechanical ventilation (IMV) or noninvasive ventilation (NIV) for at least 48 hours were selected for the study. The cases of VAP and TAV were identified according to the criteria defined by the HELICS-UCI Program of the General Directorate of Health (DGS). In 2018, 91 patients had ventilatory support 48 hours or more, and six cases of respiratory IACS were identified (five with VAP and one with VT). Tree of the patients had chronic diseases, five had active infections and all had antimicrobial therapy on admission. The mean duration of hospitalization was 21,8 days and mean duration of ventilation was 20,5 days. In patients with HAI, intrinsic and extrinsic risk factors were identified. There was an association between the development of VAP and TAV and the longer time of hospitalization and ventilation (p<0,001). It is necessary to adapt the criteria used in epidemiological surveillance to the pediatric context and to continue to focus on prevention in order to improve the health care provided to patients under mechanical ventilation.
Healthcare-associated Infections (HAI) are documented infections after 48 hours of hospital stay and are the most frequent adverse effect of hospital admissions. HAI are an increasingly important problem in pediatric ICU (PICU), especially ventilatory respiratory HAI, which are the most frequent and contribute to increased morbidity and mortality. As epidemiological surveillance is important for the control and prevention of HAI, this work aims to study the HAI related to the use of mechanical ventilation in PICU - Hospital Santa Maria (UCIPed HSM), namely pneumonia (VAP) and tracheobronchitis (VAT). Was also carried out a review on the subject. All patients admitted to the PICU in 2018 who underwent invasive mechanical ventilation (IMV) or noninvasive ventilation (NIV) for at least 48 hours were selected for the study. The cases of VAP and TAV were identified according to the criteria defined by the HELICS-UCI Program of the General Directorate of Health (DGS). In 2018, 91 patients had ventilatory support 48 hours or more, and six cases of respiratory IACS were identified (five with VAP and one with VT). Tree of the patients had chronic diseases, five had active infections and all had antimicrobial therapy on admission. The mean duration of hospitalization was 21,8 days and mean duration of ventilation was 20,5 days. In patients with HAI, intrinsic and extrinsic risk factors were identified. There was an association between the development of VAP and TAV and the longer time of hospitalization and ventilation (p<0,001). It is necessary to adapt the criteria used in epidemiological surveillance to the pediatric context and to continue to focus on prevention in order to improve the health care provided to patients under mechanical ventilation.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Infeções associadas aos cuidados de saúde Pneumonia associada à ventilação Traqueobronquite associada à ventilação Ventilação Pediatria