Factores de riesgo para neumonía asociada al ventilador en un hospital de tercer nivel de la ciudad de Medellín: estudio de casos y controles.

Contenido principal del artículo

Carlos Eduardo Afanador Bayona
Jorge Hernando Donado Gómez
Carlos Alberto Cadavid Gutiérrez

Resumen

Introducción. La neumonía asociada al ventilador (NAV) es una causa importante de morbimortalidad en pacientes que reciben ventilación mecánica (VM), a pesar de los esfuerzos para lograr un diagnóstico certero, ofrecer opciones terapéuticas apropiadas e identificar los factores de riesgo para su desarrollo como parte esencial en la prevención.


Metodología. Estudio de casos y controles con un total de 100 pacientes (relación casos: controles de 1:1) que requirieron VM durante más de 48 horas en la Unidad de Cuidados Intensivos (UCI) de un hospital de tercer nivel. Se realizó un análisis de regresión logística multivariado ingresando al modelo las variables que tenían significancia estadística en el análisis bivariado.


Resultados. La necesidad de reintubación del paciente con VM (OR 2.76, IC 95% 1.17 - 6.53) y el transporte de los pacientes por fuera de la UCI (OR 3.93, IC 95% 1.68 - 9.15), tuvieron asociación significativa con el desarrollo de NAV según el análisis bivariado. En el análisis multivariado, la única variable explicativa que permaneció asociada al desarrollo de NAV fue: transporte por fuera de la UCI (OR 4.18, IC 95% 1.64 - 10.6). De otro lado, variables como el estado de coma [Puntaje en la escala de Glasgow ≤7] (OR 5.44, IC 95% 0.61 - 48.39), sepsis (OR 2.14, IC 95% 0.84 - 5.45), enfermedad neurológica (OR 1.55, IC 95% 0.67 - 3.56) y enfermedad pulmonar obstructiva crónica [EPOC] (OR 3.27, IC 95% 0.62 a 17.7) no mostraron asociación con el desarrollo de NAV.


Conclusión. El transporte del paciente con VM por fuera de la UCI es un factor de riesgo fuertemente relacionado con el desarrollo posterior de NAV.

Palabras clave:
Neumonía asociada al ventilador factores de riesgo Unidad de Cuidados Intensivos ventilación mecánica

Citas

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Detalles del artículo

Biografía del autor/a

Carlos Eduardo Afanador Bayona, Universidad Pontificia Bolivariana

Médico y Cirujano. Universidad Pontificia Bolivariana.

Jorge Hernando Donado Gómez, Hospital Pablo Tobón Uribe

Internista y Epidemiólogo Clínico Hospital Pablo Tobón Uribe. Profesor Titular Universidad Pontifica Bolivariana.

Carlos Alberto Cadavid Gutiérrez, Hospital Pablo Tobón Uribe

Internista e Intensivista Hospital Pablo Tobón Uribe. Profesor Asociado Universidad Pontificia Bolivariana.

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