ABSTRACT
Resumen Introducción: actualmente los profesionales de la salud se enfrentan al manejo de las vías aéreas artificiales en grupos pediátricos, esto requiere de cuidados delicados y mucha atención para detectar, establecer y manejar situaciones apremiantes; por esta razón, existe un mayor riesgo de aparición de infecciones bacterianas traqueopulmonares. El objetivo del estudio fue analizar la caracterización de las infecciones en pacientes pediátricos portadores de cánula de traqueotomía en las diferentes publicaciones científicas. Materiales y métodos: se realizó una revisión sistemática mediante la búsqueda de la literatura existente entre los años 2015-2020 en las bases de datos Elsevier, PubMed, Google Académico y SciELO, teniendo en cuenta los criterios de inclusión artículos en idioma inglés, español y población de edad entre los 0-15 años con infección de cánula de traqueotomía en los años 2015-2020. Resultados: de 258 artículos distribuidos en las bases de datos, se seleccionaron 21 artículos que cumplían con los criterios de inclusión. Conclusiones: a pesar de que en la actualidad existan criterios clínicos, factores de riesgo y pruebas de laboratorio asociados a infecciones de la cánula postraqueotomía en pacientes pediátricos, se requiere mayor investigación para definir las guías clínicas de manejo en la toma de decisiones médicas. Asimismo, se consideró como limitación importante la cantidad de literatura existente con respecto al tema.
Abstract Introduction: Currently, health professionals face the management of artificial airways in pediatric groups, this requires delicate care and a lot of attention to detect, establish and manage pressing situations, which is why there is a greater risk of tracheo-pulmonary bacterial infections. The objective was to analyze the characterization of infections in pediatric patients with tracheostomy tubes in the different scientific publications. Method: A systematic review of the literature was carried out between the years 2015-2020 in Elsevier, PubMed, Google Academic and SciELO databases, taking into account the inclusion criteria of the population aged 0-15 years in the years 2015-2020. The amount of existing literature on the subject was considered an important limitation. Results: From 258 articles distributed in the databases, 21 articles were selected that met the inclusion criteria. Conclusions: Although there are currently clinical criteria, risk factors and laboratory tests associated with infections of the post-tracheotomy tube in pediatric patients, further research is required to define clinical guidelines for management in medical decision-making.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Bacterial Infections/etiology , Tracheitis/microbiology , Tracheotomy/adverse effects , Bronchitis/microbiology , Cannula/adverse effects , Respiration, Artificial/adverse effects , Bacterial Infections/diagnosis , Bacterial Infections/drug therapy , Tracheitis/diagnosis , Tracheitis/drug therapy , Bronchitis/diagnosis , Bronchitis/drug therapyABSTRACT
RESUMO O conceito de traqueobronquite associada à ventilação mecânica é controverso, e sua definição não é unanimemente aceita, sobrepondo-se, muitas vezes, à da pneumonia associada à ventilação mecânica. A traqueobronquite associada à ventilação mecânica tem incidência semelhante à da pneumonia associada à ventilação mecânica, com elevada prevalência de agentes multirresistentes isolados, condicionando um aumento do tempo de ventilação mecânica e de internação, ainda que sem impacto na mortalidade. A realização de culturas quantitativas pode permitir melhor definição diagnóstica da traqueobronquite associada à ventilação mecânica, possivelmente evitando o sobrediagnóstico desta entidade. Uma das maiores dificuldades na diferenciação entre traqueobronquite associada à ventilação mecânica e pneumonia associada à ventilação mecânica reside na exclusão de um infiltrado pulmonar por meio da radiografia do tórax; também podem ser necessárias a tomografia computadorizada torácica, a ultrassonografia torácica ou ainda a colheita de amostras invasivas. A instituição de terapêutica antibiótica sistêmica não demonstrou melhorar o impacto clínico da traqueobronquite associada à ventilação mecânica, nomeadamente na redução do tempo de ventilação mecânica, de internação ou mortalidade, apesar da eventual menor progressão para pneumonia associada à ventilação mecânica, ainda que existam dúvidas relativas à metodologia utilizada. Deste modo, considerando a elevada prevalência da traqueobronquite associada à ventilação mecânica, o tratamento desta entidade, por rotina, resultaria em elevada prescrição antibiótica sem benefícios claros. No entanto, sugerimos a instituição de terapêutica antibiótica em doentes com traqueobronquite associada à ventilação mecânica e choque séptico e/ou agravamento da oxigenação, devendo ser realizados simultaneamente outros exames auxiliares de diagnóstico para exclusão da pneumonia associada à ventilação mecânica. Após esta revisão da literatura, entendemos que uma melhor diferenciação entre traqueobronquite associada à ventilação mecânica e pneumonia associada à ventilação mecânica pode diminuir, de forma significativa, a utilização de antibióticos em doentes críticos ventilados.
ABSTRACT The concept of ventilator-associated tracheobronchitis is controversial; its definition is not unanimously accepted and often overlaps with ventilator-associated pneumonia. Ventilator-associated tracheobronchitis has an incidence similar to that of ventilator-associated pneumonia, with a high prevalence of isolated multiresistant agents, resulting in an increase in the time of mechanical ventilation and hospitalization but without an impact on mortality. The performance of quantitative cultures may allow better diagnostic definition of tracheobronchitis associated with mechanical ventilation, possibly avoiding the overdiagnosis of this condition. One of the major difficulties in differentiating between ventilator-associated tracheobronchitis and ventilator-associated pneumonia is the exclusion of a pulmonary infiltrate by chest radiography; thoracic computed tomography, thoracic ultrasonography, or invasive specimen collection may also be required. The institution of systemic antibiotic therapy does not improve the clinical impact of ventilator-associated tracheobronchitis, particularly in reducing time of mechanical ventilation, hospitalization or mortality, despite the possible reduced progression to ventilator-associated pneumonia. However, there are doubts regarding the methodology used. Thus, considering the high prevalence of tracheobronchitis associated with mechanical ventilation, routine treatment of this condition would result in high antibiotic usage without clear benefits. However, we suggest the institution of antibiotic therapy in patients with tracheobronchitis associated with mechanical ventilation and septic shock and/or worsening of oxygenation, and other auxiliary diagnostic tests should be simultaneously performed to exclude ventilator-associated pneumonia. This review provides a better understanding of the differentiation between tracheobronchitis associated with mechanical ventilation and pneumonia associated with mechanical ventilation, which can significantly decrease the use of antibiotics in critically ventilated patients.
Subject(s)
Humans , Tracheitis/drug therapy , Bronchitis/drug therapy , Anti-Bacterial Agents/therapeutic use , Respiration, Artificial/adverse effects , Tracheitis/diagnosis , Tracheitis/etiology , Bronchitis/diagnosis , Bronchitis/etiology , Critical Illness , Drug Resistance, Multiple, Bacterial , Diagnosis, Differential , Pneumonia, Ventilator-Associated/diagnosis , Pneumonia, Ventilator-Associated/drug therapyABSTRACT
We present the case of a 54-year-old male, who presented with respiratory complaints four months after he underwent renal transplantation. Bronchoscopy showed ulcerated mucosa of the left main bronchus and computed tomography (CT) of the thorax showed foci of air within the bronchial wall. A biopsy from the lesion showed septate fungal hyphae, dichotomously branching at acute angles. A locally invasive Aspergillus ulcerative tracheobronchitis with no parenchymal involvement is an important cause of tracheobronchitis in post-renal transplant patients. An early diagnosis and institution of appropriate treatment can improve the outcome. A combination treatment of caspofungin and voriconazole can be considered if patient is not responding to voriconazole alone.
Subject(s)
Antifungal Agents/administration & dosage , Aspergillosis/diagnosis , Aspergillosis/drug therapy , Aspergillosis/etiology , Aspergillosis/physiopathology , Biopsy , Bronchitis/diagnosis , Bronchitis/drug therapy , Bronchitis/etiology , Bronchitis/physiopathology , Bronchoscopy/methods , Early Diagnosis , Echinocandins/administration & dosage , Humans , Kidney Transplantation/adverse effects , Lung/pathology , Male , Middle Aged , Pyrimidines/administration & dosage , Tomography, X-Ray Computed , Tracheitis/diagnosis , Tracheitis/drug therapy , Tracheitis/etiology , Tracheitis/physiopathology , Treatment Outcome , Triazoles/administration & dosage , Ulcer/etiology , VoriconazoleABSTRACT
A case of invasive aspergillosis caused by Aspergillus niger in a lung transplant recipient is described. The patient presented hyperglycemia starting postoperatively, with other complications such as cytomegalovirus infection. The associated predisposing factors and other implications are discussed. Aspergillus niger seems to be a fungal species of low virulence that requires the presence of a severely immunosuppressed host to cause invasive disease.
Descreve-se um caso de aspergilose invasiva causada por Aspergillus niger em um paciente transplantado de pulmão com quadros hiperglicêmicos desde o pós-operatório e outras complicações como infecção por citomegalovírus. Os fatores predisponentes associados e outras implicações são discutidos. Aspergillus niger parece ser uma espécie fúngica de baixa virulência, necessitando a presença de um hospedeiro gravemente imunodeprimido para causar doença invasiva.
Subject(s)
Female , Humans , Middle Aged , Aspergillosis/etiology , Aspergillus niger/isolation & purification , Bronchitis/microbiology , Lung Diseases, Fungal/microbiology , Lung Transplantation/adverse effects , Tracheitis/microbiology , Aspergillosis/diagnosis , Bronchitis/diagnosis , Fatal Outcome , Immunocompromised Host , Lung Diseases, Fungal/diagnosis , Tracheitis/diagnosisABSTRACT
Croup or viral laryngotracheobronchitis is a very common paediatric condition. It presents with inspiratory stridor, barking cough and sometimes respiratory distress, following a viral upper respiratory tract infection. The condition has a very good prognosis and responds well to therapy, if required. However, other conditions may mimic it and doctors are always aware of the need to exclude a foreign body aspiration and not to overlook a potential life threatening epiglotittis, much less common now with the successful immunisation against Haemophilus influenzae type B [HiB]. A less well known respiratory tract infection, bacterial tracheitis, can also mimic croup. As it is potentially fatal if unrecognised, it is vital to diagnose it early. Luckily, if suspected early, an immediate and specific management is associated with an excellent prognosis. We describe two children, initially managed as croup, who developed this condition. We discuss when bacterial tracheitis should be suspected, how to differentiate it from the extremely common croup, and how to diagnose and treat it
Subject(s)
Humans , Male , Tracheitis/microbiology , Bacterial Infections , Airway Obstruction , Tracheitis/diagnosis , Croup , EmergenciesABSTRACT
La traqueitis continúa siendo una causa importante de obstrucción reversible de la vía aérea y está presente en 5 a 14% de pacientes que requieren terapia intensiva. La traqueitis exudativa es una variedad menos lesiva en niños mayores y habitualmente responde a tratamiento local o sistémico, sin intubación traqueal.
Subject(s)
Child , Respiration , Tracheitis/diagnosis , Tracheostomy/rehabilitationABSTRACT
La traqueítis bacteriana es una entidad potencialmente fatal que ha reaparecido en la última década con inusitado auge. A propósito de su detección en nuestro servicio decidimos realizar un estudio retrospectivo en el Hospital Universitario de la Misericordia de Santa Fe de Bogotá entre enero de 1990 y julio de 1994. Se revisaron 88 historias de pacientes con diagnósticos clínico sugestivo de traqueítis bacteriana pero sólo 13 pacientes cumplieron con el requisito de confirmación endoscópica del diagnóstico para ser considerados en el presente trabajo. La edad osciló entre 1 y 7 años, predominando el sexo masculino. Existió antecedente de infección respiratoria previa en el 54 por ciento, los síntomas más frecuentes fueron fiebre, tos perruna y dificultad respiratoria; los hemogramas mostraron leucocitosis, neutrofilia y aumento de la VSG. En la endoscopia se observó exudado traqueal, membranas purunlentas y úlceras; en solo cultivo se aisló Staphylococcus aureus. El 62 por ciento requirió permeabilizar la vía aérea, 3 con traqueostomía y 5 con tubo orotraqueal. El 46 por ciento se manejó con oxacilina y todos evolucionaron satisfactoriamente.
Subject(s)
Humans , Endoscopy , Endoscopy/instrumentation , Endoscopy/trends , Endoscopy/statistics & numerical data , Tracheitis/classification , Tracheitis/complications , Tracheitis/diagnosis , Tracheitis/drug therapy , Tracheitis/epidemiology , Tracheitis/etiology , Tracheitis/microbiology , Tracheitis/mortality , Tracheitis/physiopathology , Tracheitis/therapy , Oxacillin/therapeutic use , Staphylococcus aureus/pathogenicity , Tracheostomy , Tracheostomy/instrumentation , Tracheostomy/trends , Tracheostomy/statistics & numerical dataABSTRACT
Las enfermedades de vías respiratorias superiores y sus complicaciones pueden poner en peligro la vida; por consiguiente, se necesita un método sistemático para el diagnóstico rápido y tratamiento adecuado. Al analizar los signos y síntomas se puede establecer un diagnóstico diferencial. Las infecciones graves de vías respiratorias superiores pueden situarse en tres categorías expuestas en este artículo: síndrome catarral agudo, síndrome de amigdalofaringitis o síndrome de crup laríngeo. Este sistema de clasificación hace que el diagnóstico sea rápido y permita que el tratamiento adecuado se inicie con prontitud