Ebook Infection control in the intensive care unit (3rd edition): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Infection control in the intensive care unit (3rd edition): Part 2
Ebook Infection control in the intensive care unit (3rd edition): Part 2
Part IVInfections on ICULower Airway Infection14J. Almirall, A. Liapikou, M. Ferrer and A. Torres14.1DefinitionLower respiratory tract infections (RTI Ebook Infection control in the intensive care unit (3rd edition): Part 2I) in intubated patients include ventilator-associated tracheobronchitis (V/\T) and ventilator-associated pneumonia (VAP). Both arc hospital-acquired infections that occur within 4X h after intubation 11, 2J. Diagnostic criteria for VAT and VAP overlap in terms of clinical signs and symptoms. In con Ebook Infection control in the intensive care unit (3rd edition): Part 2trast to VAT, VAP requires the presence of new and persistent pulmonary infiltrates on a chest radiograph, which may be difficult to interpret in someEbook Infection control in the intensive care unit (3rd edition): Part 2
critically ill patients, and two or more of the following criteria: fever (>38.3°C) or hypothermia; leukocyte count >1 ().()()()/|.tl: purulent trachPart IVInfections on ICULower Airway Infection14J. Almirall, A. Liapikou, M. Ferrer and A. Torres14.1DefinitionLower respiratory tract infections (RTI Ebook Infection control in the intensive care unit (3rd edition): Part 2e US centers for disease control and prevention definitions, patients with a clinical pulmonary infection score >6 arc also considered to have pneumonia [3].The apparent crude incidence of VAT ranges from 3 to 10%, but it is difficult to determine the exact incidence and importance of VAT for severa Ebook Infection control in the intensive care unit (3rd edition): Part 2l reasons. The major reason is that to confirm the absence of infiltrates on a chest radiograph, a computed tomography (CT) scan is required. VAT is pEbook Infection control in the intensive care unit (3rd edition): Part 2
robably an intermediate process between lower respiratory tract colonization and VAP. Postmortem studies show a continuum between bronchitis and pneumPart IVInfections on ICULower Airway Infection14J. Almirall, A. Liapikou, M. Ferrer and A. Torres14.1DefinitionLower respiratory tract infections (RTI Ebook Infection control in the intensive care unit (3rd edition): Part 2te it from late-onsct VAP, which develops thereafter.A. Torres (t>4)Servei de Pneuinologia i Al-lèrgia Respiratòria,Hospital Clinic. Barcelona. Spain e-mail: atorres®ub.eduH. K. F. van Saene et al. (eds.). Infection Control in the Intensive Care Unit,219DOI: 10.1007/978-88-470-160i-9_ 14, © Springer Ebook Infection control in the intensive care unit (3rd edition): Part 2-Verlag Italia 2012220J. Almirall et al.The term ventilator-associated pneumonia, however, is a misnomer, as the MV is not the main risk factor for luEbook Infection control in the intensive care unit (3rd edition): Part 2
ng colonization and pneumonia. The endotracheal tube (ETT) seems to play the most important role in the pathogenesis of VAP. as it creates a direct coPart IVInfections on ICULower Airway Infection14J. Almirall, A. Liapikou, M. Ferrer and A. Torres14.1DefinitionLower respiratory tract infections (RTI Ebook Infection control in the intensive care unit (3rd edition): Part 2sk of pneumonia. Indeed, lungs become highly susceptible to bacterial colonization when injurious ventilatory settings arc applied, i.c., with high tidal volumes and low positive end expiratory pressures (PEEP).Therefore, either ETT-associated pneumonia or ventilation-acquired pneumonia arc better t Ebook Infection control in the intensive care unit (3rd edition): Part 2erms to describe pneumonia in (radically intubated and MV patients, as they emphasize the role of ETT and MV in the pathogenesis of such pneumonia. ThEbook Infection control in the intensive care unit (3rd edition): Part 2
e term ventilation-acquired pneumonia would allow' physicians and scientists to maintain the current acronym VAP [5J.14.2PathogenesisTracheal ly intubPart IVInfections on ICULower Airway Infection14J. Almirall, A. Liapikou, M. Ferrer and A. Torres14.1DefinitionLower respiratory tract infections (RTI Ebook Infection control in the intensive care unit (3rd edition): Part 2nintubated patients, colonization is prevented by several defense mechanisms, such as cough, cilia, mucous clearance, polymorphonuclear leukocytes, macrophages and their respective cytokines, antibodies I immunoglobulin (Ig)M, IgG, IgA I, and complement factors. Critically ill patients arc already a Ebook Infection control in the intensive care unit (3rd edition): Part 2t high risk of infection because of the illness, comorbidilics, and malnutrition. In MV patients, the tracheal tube may encourage aspiration by bypassEbook Infection control in the intensive care unit (3rd edition): Part 2
ing normal defenses, allowing secretions to pool in the upper part of the trachea. It also creates a direct conduit for bacteria to reach the airways,Part IVInfections on ICULower Airway Infection14J. Almirall, A. Liapikou, M. Ferrer and A. Torres14.1DefinitionLower respiratory tract infections (RTI Ebook Infection control in the intensive care unit (3rd edition): Part 2a. When endotracheal tubes arc inserted nasally instead of orally, sinusitis is significantly more likely to occur through blockage of the sinus ostia. The occurrence of nosocomial sinusitis has been associated with VAP.High-volume, low-pressure, endotracheal tube cuffs, commonly used during prolong Ebook Infection control in the intensive care unit (3rd edition): Part 2ed MV, arc not leakproof, and micro- and macroaspiration of bactcria-ladcn oropharyngeal secretions often occurs. Patients arc colonized from exogenouEbook Infection control in the intensive care unit (3rd edition): Part 2
s bacterial sources via the hands and apparel of healthcare personnel, contaminated aerosols, and invasive devices such as tracheal aspiration cathetePart IVInfections on ICULower Airway Infection14J. Almirall, A. Liapikou, M. Ferrer and A. Torres14.1DefinitionLower respiratory tract infections (RTI Ebook Infection control in the intensive care unit (3rd edition): Part 2e primary source of infection (oropharynx, stomach). It is well acknowledged, however, that in critically ill patients, oral flora quickly shifts to a predominance of aerobic Gram-negative pathogens Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). Following bacterial as Ebook Infection control in the intensive care unit (3rd edition): Part 2piration and colonization of the proximal airways, the occurrence of VAP mainly depends on the size of the inoculum, functional status, exposure to anEbook Infection control in the intensive care unit (3rd edition): Part 2
tibiotics, and potential host defenses.14 Lower Airway Infection22114.3EpidemiologyNosocomial pneumonia accounts for 31% of all nosocomial infections,Part IVInfections on ICULower Airway Infection14J. Almirall, A. Liapikou, M. Ferrer and A. Torres14.1DefinitionLower respiratory tract infections (RTI Ebook Infection control in the intensive care unit (3rd edition): Part 2n due to overlapping lower R'l ls and the difficulty in diagnosing VAP correctly. The incidence of VAI’ ranges from 9 to 67% of patients on MV. The rate of VAP. expressed as the total number of episodes of VAP/1,000 ventilator days, ranges from 5 to 16 Ị6|. VAP can increase the lime on a ventilator Ebook Infection control in the intensive care unit (3rd edition): Part 2by 10 days, length of 1CU slay by 6 days, and length of total hospital stay by I I days.Disease incidence depends greatly on the type of population stEbook Infection control in the intensive care unit (3rd edition): Part 2
udied, the presence or absence of risk factors for colonization by multi-drug-rcsiSlant pathogens, and the type and intensity of preventive strategiesPart IVInfections on ICULower Airway Infection14J. Almirall, A. Liapikou, M. Ferrer and A. Torres14.1DefinitionLower respiratory tract infections (RTI Ebook Infection control in the intensive care unit (3rd edition): Part 2 in the first week of MV). A onc-day point-prevalence study conducted in 1.417 intensive care units (ICUs) in Western Europe reported that VAP was the most common ICU-acquircd infection and MV was associated with a threefold increased risk of developing pneumonia [7], Studies conducted in several co Ebook Infection control in the intensive care unit (3rd edition): Part 2untries in the European Union have shown varying incidence density ranging from approximately 9-25 cases/ I,(XX) ventilation days (6|. EpidemiologicalEbook Infection control in the intensive care unit (3rd edition): Part 2
studies on a large United Stales database with medical, surgical, and trauma patients have shown a VAP incidence of 9.3%.Hospital mortality rate of pPart IVInfections on ICULower Airway Infection14J. Almirall, A. Liapikou, M. Ferrer and A. Torres14.1DefinitionLower respiratory tract infections (RTI Ebook Infection control in the intensive care unit (3rd edition): Part 2lics, illness severity, pathogens, and quality of antibiotic treatment 11 J. Ventilated ICU patients with VAP appear to have a two- to tenfold higher risk of death compared with patients without pneumonia. However, several patients with VAP die and not because of VAP. However, mortality rates vary f Ebook Infection control in the intensive care unit (3rd edition): Part 2rom one study to another, and the prognostic impact is debated. It is well recognized that one-third to one-half of all VAP deaths arc directly attribEbook Infection control in the intensive care unit (3rd edition): Part 2
utable to the disease. Mortality rates arc higher when VAP associated with bacteremia, especially with /< aeruginosa or Acinetobaeter spp., medical raPart IVInfections on ICULower Airway Infection14J. Almirall, A. Liapikou, M. Ferrer and A. Torres14.1DefinitionLower respiratory tract infections (RTI Ebook Infection control in the intensive care unit (3rd edition): Part 2op VAP during a hospital stay remain longer in the ỈCU and the hospital, and the increased level of care and need for additional invasive procedures drastically increases healthcare costs. It has been reported that each case of VAP is associated with additional hospital costs of $2(XXX) to more than Ebook Infection control in the intensive care unit (3rd edition): Part 2 US $4(XXX). Infection with MRSA increases hospital costs by an additional $7731 per patient. These data emphasize the need for prevention and betterEbook Infection control in the intensive care unit (3rd edition): Part 2
outcomes |8J.222J. Almirall et al.14.4Etiologic AgentsThe etiological cause of VAP is usually identified via semiquantitative microbiologic analysis oPart IVInfections on ICULower Airway Infection14J. Almirall, A. Liapikou, M. Ferrer and A. Torres14.1DefinitionLower respiratory tract infections (RTI Ebook Infection control in the intensive care unit (3rd edition): Part 2 of lung infection, samples from the lower respiratory tract are collected and quantitative cultures performed. Pathology studies clearly show that the sensitivity of microbiological studies is drastically reduced when antibiotics are administered. Therefore, new antibiotics should be administered a Ebook Infection control in the intensive care unit (3rd edition): Part 2fter sampling. Specimens can be obtained noninvasivcly via a tracheal suction catheter or invasivcly through an FOB. When an FOB is used, pathogens frEbook Infection control in the intensive care unit (3rd edition): Part 2
om the lower respiratory tract arc retrieved mainly through bronchoalveolar lavage (BAL) or protected specimen brush (PSB). Several modifications of tGọi ngay
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