Pneumonia nosocomial em pacientes críticos submetidos à higiene oral de rotina : perfil epidemiológico, escore de gravidade e nível de estabilidade genômica.

Abstract

According to ANVISA, pneumonia accounts for 15% of Health Care-related Infections and 25% of all infections in Intensive Care Units (ICUs). Most of them appear between 48-72 hours after orotracheal intubation and an institution of invasive mechanical ventilation. In these cases it is known as Mechanical Ventilation Associated Pneumonia (VAP). The implantation of an oral hygiene protocol with chlorhexidine in critical patients and other preventive measures may reduce its incidence and hospital costs, since oral biofilm is a reservoir of respiratory pathogens. Concomitant to inflammatory and/or infectious processes, cell DNA damage and changes in blood levels of reactive C protein (CRP), considered an inflammatory biomarker. It is necessary to know the level of severity presented by the critical patients, which can be reached using the Simplified Acute Physiological Score (SAPS 3), in order to give greater care to patients thar present greater risks. Objective: to compare the epidemiological profile and severity score of patients hospitalized in the ICU of a Hospital of Vale do Taquari - RS, between January to June 2016, and to verify the genomic stability and the CRP values of these patients, after being submitted to a routine oral hygiene protocol, among other measures to prevent pneumonia. Article I: "Epidemiological profile, severity score and prevalence of nosocomial pneumonia in critically ill patients submitted to routine oral hygiene". The objective of this article was to describe the epidemiological profile; severity score and prevalence of nosocomial pneumonia in patients admitted to the ICU of a Hospital of Vale do Taquari - RS, Brazil, submitted to routine oral hygiene. In order to perform this study, data were collected from the medical records of patients admitted to the adult ICU of the Born Bruno Hospital from January to June 2016. It was identified in the sample studied that the prevalence of nosocomial pneumonia in the study population is within of parameters described in the literature, since it selected patients with no history of previous hospitalization or recent pulmonary injuries. Article II: "Association between severity score, genomic stability level and C-reactive protein of critical patients submitted to routine oral hygiene". The objective of the present article was to verify and associate the severity score to levels of genomic damage and RCP dosages presented by patients hospitalized in the ICU of a medium - sized Hospital of Vale do Taquari - RS, Brazil, submitted to the systematization of hygiene oral. It was verified that the permanence of the critical patient in the ICU implied in greater genomic damages to the same ones, since these increased after 72 hours of the admission. The patients considered more serious also presented greater damages to the DNA. No significant relationship was observed between CRP and SAPS 3 score. Final Considerations: It was clear the importance of know the epidemiological characteristics of critical patients attended, in order to better target treatment strategies and institute protocols for the prevention of pneumonia in ICUs to reduce prevalence.