NEUMONÍA ASOCIADA A

VENTILACIÓN MECÁNICA

KILLLEN BRIONES CLAUDETT

48 HORAS NEUMONIA ADQUIRIDA
DESPUES QUE EL
PCTE HA SIDO DEFINICIONES EN EL HOSPITAL 48 H
DESPUES DE HABERSE
INTUBADO HOSPITALIZADO

AQUÍ ESTAN CONCEPTOS

 S
DX DEFINITIVO
HAY QUE AISALR AL
GERMEN
PATOGENIA

BIOFILM DEL TUBO

ENDOTRAQUEAL ESTA LA
BACTERIA
FACTORES DE RIESGO
FACTORES DE RIESGO
 Neumonía Neumococica

Neumonía por streptococco y stafilococo

Una alternativa a este mismo escenario es realizar una
Es más sensible
tomografía computada de tórax (TC) Esque
máslasensible
radiografía
quefrontal
la radiografía
de tórax.
frontal de tórax.
DX BRONCOSCOPIA POR CEPILLADO ASPIRADO POR
SECRECION DEL TUBO ENDOTRAQUEAL
10 A LA 5 UNIDADES FORMADORES DE
COLONIAS POR ASPIRADO CEPPILLADO
BRONQUIAL
10 A LA 4 broncosopia , lavo bronquial
 Date of download: 1/11/2016
Copyright © American College of Chest Physicians. All rights reserved.

From: The Ventilator-Associated Pneumonia PIRO Score: A Tool for Predicting ICU Mortality and Health-Care
Resources Use in Ventilator-Associated Pneumonia
Chest. 2008;134(6):1208-1216. doi:10.1378/chest.08-1106

Figure Legend:
Flow chart for the use of VAP PIRO score.
 Date of download: 1/11/2016
Copyright © American College of Chest Physicians. All rights reserved.

From: The Ventilator-Associated Pneumonia PIRO Score: A Tool for Predicting ICU Mortality and Health-Care
Resources Use in Ventilator-Associated Pneumonia
Chest. 2008;134(6):1208-1216. doi:10.1378/chest.08-1106

Figure Legend:
VAP PIRO score and ICU mortality in 441 VAP patients.
 Date of download: 1/11/2016
Copyright © American College of Chest Physicians. All rights reserved.

From: The Ventilator-Associated Pneumonia PIRO Score: A Tool for Predicting ICU Mortality and Health-Care
Resources Use in Ventilator-Associated Pneumonia
Chest. 2008;134(6):1208-1216. doi:10.1378/chest.08-1106

Figure Legend:
ROC curve comparing VAP PIRO score and APACHE II score for discrimination between survivors and nonsurvivors in the ICU in
441 VAP patients.
ojo
Tratamiento antibiótico de neumonía adquirido en el
hospital es diferente de neumonía asociada al ventilador?
 DIFERENCIAS ENTRE NEUMONIA ADQUIRIDA EN EL
HOSPITAL Y NEUMONIA ASOCIADA A LOS VENTILADORES

La HAP es una forma de neumonía nosocomial en pacientes. que no han

estado
 en un ventilador durante las 48 h de infección precedente.
HAP
 puede ocurrir fuera de la UCI o en la UCI.

HAP que se adquiere en la UCI generalmente es más severo e involucra más

potencialmente farmacorresistencia
 DIFERENCIAS ENTRE NEUMONIA ADQUIRIDA EN EL
HOSPITAL Y NEUMONIA ASOCIADA A LOS VENTILADORES
• What is pharmacokinetics
 • What is pharmacokinetics

 The volume of distribution (Vd): is the initial dose divided by the plasma
concentration occurring immediately after administration.
 Clearance (Cl): represents the volume of blood, serum or plasma completely
cleared of drug per unit of time.
 Elimination half-life (t1/2): the time it takes for the concentration of the drug
to fall to 50%.
 Cmax (peak): peak serum drug concentration achieved by a single dose.
 Cmin (trough): minimum serum drug concentration during a dosing period.
 AUC: area under the serum concentration curve.
 • What is pharmacokinetics

Pharmacokinetics of septic patients

 Signs of a capillary leak,

 Increased cardiac output
 Modification of serum protein levels and binding

 In these situations, antibiotic dosing is especially challenging due to an

increased volume of distribution (Vd) and changes in clearance (Cl).

 Additionally, general renal and hepatic dysfunction may lead to significant

pharmacokinetic changes.
 • What is pharmacokinetics

Class Solubility Protein binding Vd Clearance

Beta-Lactams Hydrophilic Low to moderate* Low Predominantly renal

Vancomycin Hydrophilic Moderate Low Predominantly renal

Hepatic metabolism & renal

Fluoroquinolones Lipophilic Low to moderate Moderate
clearance

Macrolides Lipophilic Variable High Predominantly hepatic

Aminoglycosides Hydrophilic Low Low Predominantly renal

Clindamycin Lipophilic High High Predominantly hepatic

Metronidazole Hydrophilic Low High Predominantly renal

 • What is pharmacodynamics?
Minimum inhibitory concentration (MIC)
 It is a static measure and is not reflective of the fluctuating drug concentrations typically
observed during the dosing interval.
 Because the MIC measures only growth inhibition, it does not reflect the rate at which
bacteria are killed, nor can it identify if an exposure-kill response relationship exists for a
particular antibiotic-microorganism pairing.
 The MIC quantifies net growth only over an 18- to 24-hour observation period. Killing
and re-growth may well occur during this period, as long as the net growth is zero.
 It does not account for post-antibiotic effects of antibiotics.
 Inhibition of visible growth does not mean that organisms were killed (bacteriostatic vs
bactericidal)
 Breakpoints are often subjective and may not correlate with clinical outcomes
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