الفهرس | Only 14 pages are availabe for public view |
Abstract Ventilator-associated pneumonia (VAP) is nosocomial infection that develops following at least 48 hours of mechanical ventilation. It can be divided into the following two categories based on duration of mechanical ventilation: early onset VAP (occurring on days 2-4) and late onset VAP (occurring on days ≥5). A third category is based on the risk of VAP being caused by multidrug resistant pathogens, but occurring on days 2-4. The main risk factor for ventilator associated pneumonia is the presence of the ETT, as it impairs natural defense mechanisms such as cough reflex and mucociliary clearance, and allows for direct communication between the oral-supraglottic space and the lower respiratory tract. Ventilator associated pneumonia can be prevented by reduce duration of mechanical ventilation, body positioning either in semisetting or lateral position, tube modification, airway care and kinetic therapy. With the development of MDR gram negative infections such as Acinetobacter baumannii and Pseudomonas aeruginosa, the use of aerosolized antimicrobials in the ICU has been restudied. Aerosolized antibiotics kill large numbers of bacteria in the tracheobronchial tree and reducing the bacterial load at the source of infection without the need for high serum levels. The main side effects of neblized antibiotics are local irritanat effects, systemic side effects, lack of legal concern, cost and emergence of resistant strains. The aim of the work was to asses efficacy and safety of nebulized ceftazidime and amikacin in treatment of ventilator associated pneumonia as adjunctive to intravenous systemic antibiotics in EL-abbasia chest hospital ICU in six months from january 2014 till july 2014. All patients were subjected to full history talking, full clinical examination (general and local), laboratory investigations, chest xray and sputum culture by tracheal aspirate through endotracheal tube. This study included 36 patients categorized into two groups: Case group: Seven Patients received nebulized ceftazidime (15mg/kg/3h) and eleven patients received nebulized amikacin (25mg/kg/d) as adjunctive to systemic antibiotics, (No=18). Control group: eighteen Patients received systemic antibiotics only according to sputum culture and sensitivity, (No=18). Our results showed no significant difference between aerosolized and control groups as regard to age and sex, FIO2, pao2 but TLC siginificantly decreased in aerosolized group than control group and TEMPERATURE significantly decreased in aerosolized and control groups. Days of mechanical ventilation and days of ICU stay were significantly shorter in aerosolized group than control group. Mortality was non-significantly less frequent in case group than control group; Survival was non-significantly more frequent in control group case than group. |