Prevención de la neumonía asociada a ventilación mecánica en el post-operatorio de cirugía cardiaca

Resum

Ventilator-associated pneumonia (VAP) is the most frequent infection in patients admitted to the intensive care unit (ICU). It is associated with prolonged hospital stay, increased health care costs, and an attributable mortality rate of 15-45%. Patients undergoing Major Heart Surgery (MHS) are at a higher risk of developing nosocomial Infections, and particularly of developing VAP. Infection may respond directly or indirectly, at least 50% of mortality in these circumstances. The patients remaining ventilated more than 48 hours after MHS are a group at a particular risk of infectious complications particularly of VAP that may reach an incidence of 46% of the patients. Prevention is the main objective of the approach to patients at risk of VAP and the work collected in this Memory of Doctoral Thesis is a scientific line, consisting in several study pieces to asses different aspects of the prevention of VAP. Those main objectives were as follows: 1- To assess the knowledge of the guidelines for prevention of VAP among healthcare workers (HCWs) in adult ICUs. 2- To study the impact of the introduction of Aspiration of Subglottic Secretions in the Prevention of Ventilator-Associated Pneumonia in the Postoperative Period of Major Heart Surgery, its cost, efficacy and safety. 3- To determine whether a short course of broad-spectrum antimicrobial agents could reduce the incidence or delay the onset of lower respiratory tract infections (LRT) in this high-risk population. 4- To study the impact of four sequentially implemented measures to reduce VAP in an MHS-ICU...