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      Sistemas de aspiración: incidencia en neumonía asociada a ventilación mecánica y efectos hemodinámicos Translated title: Suction systems: incidence of ventilator associated pneumonia and hemodynamic effects

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          Abstract

          Resumen Introducción: la neumonía asociada a ventilación mecánica se caracteriza por presentarse en pacientes con uso de vía aérea artificial, es la segunda causa de infección nosocomial en el paciente crítico, aumenta la mortalidad y los días de hospitalización. Los sistemas de aspiración forman parte de las medidas de prevención de este tipo de neumonía, además ambos presentan cambios en los parámetros hemodinámicos sin mantener un estándar claro respecto a superioridad sobre cada uno de estos. Objetivos: realizar una comparación de los dos tipos de sistemas de aspiración y su relación con la NAVM y las complicaciones hemodinámicas relacionadas a través de una revisión sistemática. Metodología: se realizó una revisión sistemática guiada por la formulación de una pregunta estructurada en base a formato PICO considerando el tipo de sistema de aspiración utilizado, incidencia de NAVM y complicaciones hemodinámicas asociadas. Resultados: se incluyeron 12 artículos separados en dos grupos – relación entre sistemas de aspiración y neumonía asociada a ventilación mecánica y relación entre sistemas de aspiración e impacto en la hemodinamia –, se incluyeron estudios de 10 países, los rangos de edad media para ambos grupos radican entre los 62,54 años y 57,62 años. Del primer grupo la relación causal entre el tipo de sistema de aspiración y la presencia de neumonía asociada a ventilación mecánica no evidencia significancia sustancial (valor P>0.05); en el segundo grupo se identifican en la mayoría de los documentos factores relacionados a cambios en la hemodinamia de acuerdo al tipo de sistema de aspiración utilizado como son alteraciones en saturación de oxígeno, frecuencia cardiaca y presión arterial media (valor P>0.05) y en un grupo menor se identifican cambios en la saturación arterial de oxígeno. Discusión y conclusión: no se logró determinar un impacto sobre cuál tipo de sistema de aspiración genera una mantención y/o disminución de la neumonía asociada a ventilación mecánica debido a la falta de significancia estadística, es relevante indicar que en la mayoría de las variables hemodinámicas existió una variación de los parámetros.

          Translated abstract

          Abstract Introduction: ventilation-associated pneumonial is characterized for presenting in patients with use of artificial airway, it is the second cause of nosocomial infection in critically ill patients, it increases mortality and days of hospitalization. Aspiration systems are part of the prevention measures for this type of pneumonia, in addition, both present changes in hemodynamic parameters without maintaining a clear standard regarding superiority over each other. Objectives: to make a comparison of the two types of aspiration systems and their relationship with VAP and related hemodynamic complications through a systematic review. Methodology: a systematic review was carried out guided by the formulation of a structured question based on the PICO format considering the type of aspiration system used, incidence of VAP and associated hemodynamic complications. Results: there were included 12 articles separated into two groups - relationship between aspiration systems and pneumonia associated with mechanical ventilation and relationship between aspiration systems and impact on hemodynamics – there were included studies from 10 countries, the mean age ranges for both groups was between 62.54 years and 57.62 years. In the first group, the causal relationship between the type of aspiration system and the presence of pneumonia associated with mechanical ventilation does not show substantial significance (P value> 0.05); In the second group, factors related to changes in hemodynamics are identified in most of the documents according to the type of suction system used, such as alterations in oxygen saturation, heart rate and mean arterial blood pressure (P value> 0.05) and in a smaller group identifies changes in arterial oxygen saturation. Discussion and conclusion: it was not possible to determine an impact on which type of aspiration system generates maintenance or reduction of ventilation-associated pneumonial due to the lack of statistical significance, it is relevant to indicate that in most of the hemodynamic variables there was a variation of the parameters.

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          Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.

          It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.
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            Closed tracheal suction systems for prevention of ventilator-associated pneumonia.

            We have assessed the evidence that closed tracheal suction systems (TSS) prevent ventilator-associated pneumonia (VAP), using a meta-analysis of randomized controlled trials (RCTs). We searched PubMed and Cochrane databases to identify RCTs that compared closed with open TSS for the management of mechanically ventilated (MV) patients. Nine RCTs were included in the meta-analysis. There was no difference in the incidence of VAP between patients managed with closed and open TSS [odds ratio (OR)=0.96, 95% confidence intervals (CI) 0.72-1.28]. There was no heterogeneity among the eligible trials (I2=0, 95% CI 0-0.65). The compared groups did not differ with respect to mortality (OR=1.04, 95% CI 0.78-1.39) or intensive care unit (ICU) length of stay [two RCTs: 12.3 (sd 1.1) vs 11.5 (1.4) days and 15.6 (13.4) vs 19.9 (16.7) days]. Suctioning with closed systems was associated with longer MV duration (weighted mean differences: 0.65 days, 95% CI 0.28-1.03) and higher colonization of the respiratory tract (OR=2.88, 95% CI 1.50-5.52) than open TSS. The available evidence suggests that closed as opposed to open TSS usage did not provide any benefit on VAP incidence, mortality, or ICU stay of MV patients.
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              LA "GESTIÓN DEL CUIDADO" EN LA LEGISLACIÓN CHILENA: INTERPRETACIÓN Y ALCANCE

              La legislación chilena al definir el rol social de las enfermeras les asigna, entre otras funciones, la "gestión del cuidado" (1997). A partir de la Reforma de la Salud (2004), que establece una nueva Autoridad Sanitaria y Gestión, la "gestión del cuidado", pasa a formar parte de la estructura de los Servicios de Salud. En concordancia, el Reglamento de los Servicios de Salud (2005) y la Norma Administrativa Nº 19, del Ministerio de Salud (2007) entregan las bases orgánicas funcionales de las Unidades de Gestión del Cuidado, para la atención cerrada. No obstante el desarrollo legislativo observado, la expresión "gestión del cuidado", en cuanto función y estructura ha presentado dificultades interpretativas, lo que ha llevado a una confusa socialización del término. Este trabajo pretende ser un aporte en su comprensión.
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                Author and article information

                Journal
                ene
                Ene
                Ene.
                Martín Rodríguez Álvaro (Santa Cruz de La Palma, La Palma, Spain )
                1988-348X
                2021
                : 15
                : 3
                : 1211
                Affiliations
                [1] orgnameHospital Dr. Gustavo Fricke España
                [2] orgnameUniversidad de Valparaíso España
                Article
                S1988-348X2021000300010 S1988-348X(21)01500300010
                4a5b5066-7c76-43e3-9c01-058d0989acfd

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : November 2020
                : October 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 33, Pages: 0
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                SciELO Spain

                Categories
                Artículos

                revisión sistemática,hemodinamia,cuidados críticos,Neumonía asociada al ventilador,cuidados de enfermería,ventilator – associated pneumonia,systematic review,hemodynamic,critical care,nursing care

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