Abstract

MICHELETTO, Genoveva et al. Serious pneumonie as cause of entrante in adults´ICU. An. Fac. Cienc. Méd. (Asunción) [online]. 2005, vol.38, n.1-2, pp.74-85. ISSN 1816-8949.

Introduction. Pneumonia is a frequent cause of hospitalization in Adults Intensive Care Unit (AICU). Objetive: to determine clinic, demographic characteristics, evolution and risks factors associated to mortality in severe pneumonias that required admission at Hospital de Clínicas-AICU. Materials and Methods. Observational, retrospective study, from 01/07/99 to 31/07/02. Data were processed in EPI 6. Results in percents and means with SD, p value <0,05. Results. 148 patients. 54,7% female. Age 47 ± 19,5 years. 62,2% presented co-morbid condition, diabetes mellitus (20,2%), COPD (17,5%) were most frequent. Median APACHE II 18 ± 8, IGS II 40 ± 30. 29,1%: in septic shock. At admission: 83,1% needed mechanical ventilation with PaFiO2 <200: 38,5%. Microbiologic diagnosis was done: 43,5%, allowing the identification of Pseudomonas aeruginosa, Staphylococcus aureus and Enterobacter sp as the most frequent pathogens. Blood culture (+): 22,8%. Types of pneumonia: Community adquired pneumonia (CAP):48%, hospital acquired pneumonia (HAP): 34%, aspiration pneumonia (AP): 18%. Significative differences between CAP-HAP: dopamine 77,5% vs 52% (p=0,006), mechanical ventilation indication 68,25% vs 49,05% (p=0,03), pneumococcus 17,14% vs 0% (p=0,02), median PaFiO2 251,7 vs 318,4 (p=0,03). Risk factors for mortality: Glasgow Coma Score <10, culture (+), indication of mechanical ventilation, APACHE II >10, IGS II >20, two or more organic failures, septic shock, vasopressors, PaFiO2 <200 and <6 days of stay. Mortality: 44,6%, attributable to pneumonia: 47%. Conclusions. More CAP than HAP were found. All the patients were seriously sick. Mechanical ventilation was required in high percentage. In almost fifty percent a causal diagnosis was perfomed. High mortality rate was observed in both (CAP-HAP), mainly attributable to pneumonia.