Resumo

MICHELETTO, Genoveva, FERREIRA, Fernando, BAEZ, Santiago et al. Neumonía grave como causa de ingreso en la unidad de terapia intensiva de adultos. An. Fac. Cienc. Méd. (Asunción), abr. 2005, vol.38, no.1-2, p.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.