miércoles, 4 de marzo de 2015

Ventilator-associated pneumonia

Valor pronóstico de procalcitonina y PCR séricas en pacientes graves que desarrollan NAV
Prognostic value of serum procalcitonin and C-reactive protein levels in critically ill patients who developed ventilator-associated pneumonia.
Tanriverdi H, Tor MM, Kart L, Altin R, Atalay F, SumbSümbüloglu V. Ann Thorac Med 2015;10:137-42
INTRODUCTION: Ventilator-associated pneumonia (VAP) is an important cause of mortality and morbidity in critically ill patients. We sought to determine the prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) kinetics in critically ill patients who developed VAP. METHODS: Patients who were admitted to the intensive care unit (ICU) and developed VAP were eligible. Patients were followed for 28 days after the pneumonia diagnosis and blood samples for PCT and CRP were collected on the day of the pneumonia diagnosis (D0), and days 3 (D3) and 7 (D7) after the diagnosis. Patients were grouped as survivors and non-survivors, and the mean PCT and CRP values and their kinetics were assessed. RESULTS: In total, 45 patients were enrolled. Of them, 22 (48.8%) died before day 28 after the pneumonia diagnosis. There was no significant difference between the survivor and non-survivor groups in terms of PCT on the day of pneumonia diagnosis or CRP levels at any point. However, the PCT levels days 3 and 7 were significantly higher in the non-survivor group than the survivor group. Whereas PCT levels decreased significantly from D0 to D7 in the survivor group, CRP did not. A PCT level above 1 ng/mL on day 3 was the strongest predictor of mortality, with an odds ratio of 22.6.
CONCLUSION: Serum PCT was found to be a superior prognostic marker compared to CRP in terms of predicting mortality in critically ill patients who developed VAP. The PCT level on D3 was the strongest predictor of mortality in VAP.
Keywords: Intensive care unit, pneumonia, procalcitonin, prognosis

Control continuo de la presión del globo endotraqueal. ¿Medida efectiva para prevenir NAV?
Continuous control of tracheal cuff pressure: an effective measure to prevent ventilator-associated pneumonia? Rouzé A, Jaillette E, Nseir S. Crit Care. 2014 Sep 6;18(5):512. doi: 10.1186/s13054-014-0512-2.
In a previous issue of Critical Care, Lorente and colleagues reported the results of a prospective observational study aiming at evaluating the effect of continuous control of cuff pressure (Pcuff ) on the incidence of ventilator-associated pneumonia (VAP). The results suggest a beneficial impact of this intervention on VAP prevention, which is in line with the results of a recent randomized controlled study. However, another randomized controlled study found no significant impact of continuous control of Pcuff on VAP incidence. Several differences regarding the device used to control Pcuff, study population, and design might explain the different reported results. Future randomized multicenter studies are needed to confirm the beneficial effect of continuous control of Pcuff on VAP incidence. Furthermore, the efficiency and cost-effectiveness of different available devices should be compared. Meanwhile, given the single-center design and the limitations of the available studies, no strong recommendation can be made regarding continuous control of Pcuff as a preventive measure of VAP.
Precisión de tinción de Gram en aspirado traqueal en la predicción de la infección por Staphylococcus aureus en NAV
Accuracy of tracheal aspirate gram stain in predicting Staphylococcus aureus infection in ventilator-associated pneumonia. Seligman R, Seligman BG, Konkewicz L, Dos Santos RP.
BMC Anesthesiol. 2015 Jan 23;15(1):19. doi: 10.1186/1471-2253-15-19. eCollection 2015.
Anestesia y Medicina del Dolor
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