Sustantial differences exist between Intensive Care Units ICUS in developing countries concerning epidemiology EP, diagnosis DX, antibiotics abs, TX, and resources in the approach of ventilator associated pneumonia VAP. Despite the effort from International Int conferences, the real knowleadge about clinical/practical CP routines in VAP at Latinamerica (LA-ICUS) is limited. The objective was to evaluate VAP information about the CP experience in LA-ICUS.
35 questions Q about VAP was designed to collect data in person and electronically from LA-ICUS practitioners. The 1st/2nd phase started at the 1st Interamerican Consensus Conference about VAP in Morelia, México, Int LA meeting in Brazil ( May 2003), Int conference in Orlando (Nov. 2003) and the 3rd phase through e-mail correspondence. Q was classified in EP, risk factors RF, DX, etiology ET, TX, prevention PV and research RS.. Data was processed (1) and reviewed by an International guest Chairman from Mineola, NY.
Seven LA countries were enrolled. EP: 58.3% of peers recongnized differences in selected critically ill patients (p) with VAP; RF: endotracheal tube (66.7%), along with MV (41.7%); DX: Respiratory samples (Invasive, 50% and non invasive 16.7%; ET: ICU flora were defined (58.3%), qualitative 58.3% vs quantitative 41.7%; TX: by ICU team (75%) and infectious disease consultants (25%), Guidelines were followed for EAT ( Int 50%, regional 16.7%, local 16.7%). Cost (83.3%) defined combination EAT (83.3%) againts Gram negative bacilli (100%). Carbapenems are the first line of choice(50%). EAT success is evaluated (clinically 83% vs bacteriologically 8.33%), and adjusted by MIC (always 33.3%, sometimes 16.7%, and with EAT failure 25.%); PV: semirrecumbent position (83.3%), selective descontamination (8.3%), sub glotic aspiration (8.3%); RS: LA multicentric studies are mandatory to optimize VAP approach (100%).
Despite the limitation of this study, to our knowleadge this is the most recent effort to evaluate CP VAP experience in LA ICUS.
Large Multicenter LA data base is necessary to optimize and recommend future LA guidelines and/or to consider including special chapter in International guidelines.
A. Maldonado-Ortiz (1), None.