Control of bacterial pneumonia during mechanical ventilation.

摘要: Pneumonia complicates the course of 50% patients on mechanical ventilation, requiring three or more days ventilation and potentially increasing relative risk mortality by 20-40%. The predominant pathogenic micro-organisms are Streptococcus pneumoniae, Staphylococcus aureus (sensitive to methicillin in previously healthy host), Pseudomonas aeruginosa (aerobic gram-negative bacilli), methicillin-resistant host with underlying disease. Approximately 85% pneumonias endogenous, caused bacteria present patient's oropharyngeal flora. Bacteria admission cause primary endogenous pneumonia (55%), whereas acquired unit lead supercarriage secondary carriage subsequently (30%). remaining 15% exogenous, ie causing not carried patient. diagnosis is usually based clinical, radiological, microbiological criteria, using non-invasive method tracheal aspirate, which yields >/=10(5) micro-organisms. Seven randomized trials have evaluated non-antibiotic prophylactic maneuvers: hygiene (1 trial), subglottic drainage (4 trials), semirecumbent position (2 trials). impact was mixed, unchanged. Selective digestive decontamination, parenteral enteral antimicrobials control types pneumonia, has been 54 showed an absolute reduction 8%. therapy relies six basic principles: (a) surveillance diagnostic cultures identify micro-organisms; (b) immediate adequate antibiotic treatment sterilize lower airways, (c) source potential pathogens requires elimination for recovery original infection prevention relapses and/or superinfections; (d) aerosolized antimicrobials; (e) removal replacement endotracheal tube; (f) samples indispensable monitor efficacy treatment. aim our review evaluate up date facts regarding bacterial during intensive care settings.