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Influencia del manejo de las vías respiratorias en la neumonía asociada al ventilador: evidencia de ensayos
D Cook1, B De Jonghe, L Brochard
1Department of Medicine, St Joseph's Hospital and McMaster University, Hamilton, Ontario, Canada. debcook@fhs.csu.mcmaster.ca
JAMA
|March 21, 1998
Resumen
Ciertas estrategias de manejo de las vías respiratorias pueden reducir las tasas de neumonía asociada al ventilador (VAP) en pacientes en estado crítico. Factores como el uso de humidificadores, el sitio de intubación y el drenaje de la secreción influyen en el riesgo de VAP.
Área de la Ciencia:
- Medicina de cuidados críticos Medicina de cuidados críticos.
- Pulmonología Pulmonología.
- Enfermedades infecciosas Enfermedades infecciosas.
Sus antecedentes:
- La neumonía asociada al ventilador (VAP) es una causa significativa de morbilidad y mortalidad en pacientes en estado crítico.
- Numerosas intervenciones tienen como objetivo mitigar el riesgo de VAP, destacando la necesidad de una gestión de las vías respiratorias basada en la evidencia.
Objetivo del estudio:
- Revisar sistemáticamente el impacto de las estrategias de gestión de las vías aéreas en las tasas de VAP.
- Identificar intervenciones específicas que puedan reducir la incidencia de PAV en pacientes con ventilación mecánica.
Principales métodos:
- Revisión sistemática de ensayos aleatorizados publicados desde 1980 hasta julio de 1997.
- Los criterios de inclusión se centraron en el circuito del ventilador y las estrategias de gestión de la secreción que afectan a las tasas de VAP.
- Abstracción de los datos por dos investigadores independientes.
Principales resultados:
- Los cambios en el circuito del ventilador y el tipo de sistema de succión no alteraron significativamente las tasas de VAP.
- Las tasas más bajas de VAP se asociaron potencialmente con evitar los humidificadores calentados, el uso de intercambiadores de calor y humedad, la intubación oral, el drenaje de la secreción subglótica y las camas cinéticas.
Conclusiones:
- Técnicas específicas de manejo de las vías respiratorias y la secreción pueden influir en las tasas de VAP en entornos de cuidados intensivos.
- La adopción clínica de estas estrategias depende de la evidencia, el costo y la accesibilidad.
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