Artigo Original/Original Article
Pneumonia adquirida na comunidade numa unidade de cuidados intensivos
Community-acquired pneumonia in an intensive care unit
1 Interna do internato Complementar de Medicina Interna/Resident, Internal Medicine
2 Assistente de Medicina Interna, Intensivista/Consultant, Internal Medicine, Intensive Care
3 Assistente Hospitalar Graduada de Gastrenterologia, Intensivista/Consultant, Gastroenterology Specialist, Intensive Care
4 Assistente Hospitalar Graduado de Medicina Interna, Intensivista e Director da Unidade de Cuidados Intensivos Médico-Cirúrgicos/Consultant, Internal Medicine Specialist, Intensive Care, Medical-Surgical Intensive Care Unit
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"autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Raquel Marques, António Nunes, Cristina Sousa, Fausto Moura, João Gouveia, Armindo Ramos" "autores" => array:6 [ 0 => array:4 [ "nombre" => "M. Raquel" "apellidos" => "Marques" "email" => array:1 [ 0 => "mraquelmarques@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 1 => array:3 [ "nombre" => "António" "apellidos" => "Nunes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 2 => array:3 [ "nombre" => "Cristina" "apellidos" => "Sousa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "af0015" ] ] ] 3 => array:3 [ "nombre" => "Fausto" "apellidos" => "Moura" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 4 => array:3 [ "nombre" => "João" "apellidos" => "Gouveia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 5 => array:3 [ "nombre" => "Armindo" "apellidos" => "Ramos" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">4</span>" "identificador" => "af0020" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cr0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Interna do internato Complementar de Medicina Interna/Resident, Internal Medicine" "etiqueta" => "1" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Assistente de Medicina Interna, Intensivista/Consultant, Internal Medicine, Intensive Care" "etiqueta" => "2" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Assistente Hospitalar Graduada de Gastrenterologia, Intensivista/Consultant, Gastroenterology Specialist, Intensive Care" "etiqueta" => "3" "identificador" => "af0015" ] 3 => array:3 [ "entidad" => "Assistente Hospitalar Graduado de Medicina Interna, Intensivista e Director da Unidade de Cuidados Intensivos Médico-Cirúrgicos/Consultant, Internal Medicine Specialist, Intensive Care, Medical-Surgical Intensive Care Unit" "etiqueta" => "4" "identificador" => "af0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "*" "correspondencia" => "Unidade de Cuidados Intensivos Médico-Cirúrgicos, Hospital Pulido Valente, Director: Dr Armindo Ramos, Alameda das Linhas de Torres,117, 1769-001 Lisboa" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Community-acquired pneumonia in an intensive care unit" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-06-22" "fechaAceptado" => "2009-07-24" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec570117" "palabras" => array:3 [ 0 => "Infecções adquiridas na comunidade" 1 => "pneumonia" 2 => "cuidados intensivos" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec570116" "palabras" => array:3 [ 0 => "Community-acquired infections" 1 => "pneumonia" 2 => "critical care" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">A pneumonia adquirida na comunidade (PAC) é a principal causa de sépsis em cuidados intensivos de adultos. Com o objectivo de caracterizar o quadro clínico de PAC em cuidados intensivos, tratamento e avaliação de factores prognósticos, com especial relevância para a antibioterapia, realizou-se um estudo retrospectivo dos doentes admitidos numa UCI polivalente com PAC, de 1 de Junho de 2004 a 31 de Dezembro de 2006. Analisaram-se 76 doentes com uma idade média de 62,88 (18,75) anos. O APACHE II médio de 24,88 (9,75) e o SAPS 2 médio era de 51,18 (18,05), com mortalidade prevista de 47,27%. O microrganismo responsável foi identificado em 42,1% dos casos. O agente etiológico mais comum foi o <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>, mas o grupo de agentes etiológicos mais frequentemente identificados foi o dos bacilos entéricos gramnegativos.</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">A antibioterapia prévia mais usada foi a levofloxacina. O esquema de antibioterapia mais usado na admissão foi a associação ceftriaxone com azitromicina. Em 32 doentes em que foi possível avaliar a adequação terapêutica, 27 estavam sob esquemas de antibioterapia adequados. Foram submetidos a ventilação mecânica 66 doentes (86,8%), com uma duração mediana de 4 dias. A demora mediana foi de 5,3 dias. A mortalidade na unidade foi de 36,8% e a hospitalar de 55,26%.</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">O índice SAPS 2, o valor de PCR, o potássio sérico e a antibioterapia inicial não adequada relacionaram-se com maior mortalidade. Após análise multivariada, apenas o índice SAPS II manteve significado estatístico.</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">O uso da antibioterapia deve ser criterioso, tendo em conta os principais agentes e a sua susceptibilidade.</p><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010; XVI (2): 223-235</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall">Community-acquired pneumonia (CAP) is the leading cause of sepsis in adult critical care.</p><p id="sp0065" class="elsevierStyleSimplePara elsevierViewall">We present a retrospective study of patients admitted to a polyvalent intensive care unit with CAP from 1<span class="elsevierStyleSup">st</span> June 2004 – 31<span class="elsevierStyleSup">st</span> December 2006.</p><p id="sp0070" class="elsevierStyleSimplePara elsevierViewall">We analysed 76 patients with a mean age of 62.88 (18.75) years. Mean APACHE II score was 24.88 (9.75). Mean SAPS II was 51.18 (18.05), with a predicted mortality of 47.27%. Aetiology was identified in 42.1% of the patients. <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> was the most frequent aetiological agent, but the group of aetiological agents more frequently identified was Gram-negative enteric bacilli.</p><p id="sp0075" class="elsevierStyleSimplePara elsevierViewall">Levofloxacine was the most frequently previously used antibiotic. The most frequently used antibiotherapy scheme was the association ceftriaxone – azithromicine. It was possible to evaluate suitability of treatment in 32 patients; 27 were on suitable antibiotherapy regimes. 66 patients (86.8%) were on respirators, with a median length of 4 days. The median length of stay was 5.3<span class="elsevierStyleHsp" style=""></span>days. ICU mortality was 36.8% and hospital mortality 55.26%.</p><p id="sp0080" class="elsevierStyleSimplePara elsevierViewall">SAPS II, CRP (C-reactive protein), potassium and initial unsuitable antibiotherapy were related to mortality. After multivariate analysis, only SAPS II maintained statistical significance.</p><p id="sp0085" class="elsevierStyleSimplePara elsevierViewall">Use of antibiotics should be judicious, taking the most frequent agents and their susceptibility into consideration.</p><p id="sp0090" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010; XVI (2): 223-235</span></p></span>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliografia/Bibliography</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." 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Article information
ISSN: 08732159Original language: Portuguese
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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 2 | 6 |
| 2024 October | 45 | 35 | 80 |
| 2024 September | 41 | 33 | 74 |
| 2024 August | 38 | 36 | 74 |
| 2024 July | 37 | 34 | 71 |
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| 2024 May | 28 | 31 | 59 |
| 2024 April | 36 | 34 | 70 |
| 2024 March | 29 | 37 | 66 |
| 2024 February | 16 | 21 | 37 |
| 2024 January | 28 | 30 | 58 |
| 2023 December | 23 | 24 | 47 |
| 2023 November | 22 | 19 | 41 |
| 2023 October | 13 | 48 | 61 |
| 2023 September | 22 | 28 | 50 |
| 2023 August | 25 | 26 | 51 |
| 2023 July | 27 | 31 | 58 |
| 2023 June | 19 | 22 | 41 |
| 2023 May | 25 | 28 | 53 |
| 2023 April | 15 | 25 | 40 |
| 2023 March | 24 | 24 | 48 |
| 2023 February | 21 | 34 | 55 |
| 2023 January | 21 | 29 | 50 |
| 2022 December | 28 | 28 | 56 |
| 2022 November | 24 | 44 | 68 |
| 2022 October | 28 | 33 | 61 |
| 2022 September | 19 | 35 | 54 |
| 2022 August | 36 | 38 | 74 |
| 2022 July | 25 | 39 | 64 |
| 2022 June | 15 | 29 | 44 |
| 2022 May | 24 | 36 | 60 |
| 2022 April | 33 | 31 | 64 |
| 2022 March | 14 | 39 | 53 |
| 2022 February | 24 | 36 | 60 |
| 2022 January | 29 | 39 | 68 |
| 2021 December | 20 | 35 | 55 |
| 2021 November | 27 | 36 | 63 |
| 2021 October | 31 | 31 | 62 |
| 2021 September | 20 | 34 | 54 |
| 2021 August | 29 | 21 | 50 |
| 2021 July | 18 | 19 | 37 |
| 2021 June | 19 | 28 | 47 |
| 2021 May | 32 | 29 | 61 |
| 2021 April | 33 | 59 | 92 |
| 2021 March | 41 | 14 | 55 |
| 2021 February | 32 | 18 | 50 |
| 2021 January | 33 | 21 | 54 |
| 2020 December | 35 | 19 | 54 |
| 2020 November | 44 | 12 | 56 |
| 2020 October | 30 | 20 | 50 |
| 2020 September | 41 | 14 | 55 |
| 2020 August | 31 | 29 | 60 |
| 2020 July | 60 | 21 | 81 |
| 2020 June | 39 | 16 | 55 |
| 2020 May | 46 | 22 | 68 |
| 2020 April | 38 | 13 | 51 |
| 2020 March | 36 | 8 | 44 |
| 2020 February | 47 | 26 | 73 |
| 2020 January | 41 | 16 | 57 |
| 2019 December | 26 | 23 | 49 |
| 2019 November | 40 | 20 | 60 |
| 2019 October | 24 | 17 | 41 |
| 2019 September | 23 | 21 | 44 |
| 2019 August | 58 | 26 | 84 |
| 2019 July | 58 | 22 | 80 |
| 2019 June | 49 | 15 | 64 |
| 2019 May | 58 | 20 | 78 |
| 2019 April | 53 | 31 | 84 |
| 2019 March | 116 | 10 | 126 |
| 2019 February | 95 | 11 | 106 |
| 2019 January | 81 | 19 | 100 |
| 2018 December | 54 | 9 | 63 |
| 2018 November | 17 | 0 | 17 |
| 2018 October | 15 | 6 | 21 |
| 2018 September | 24 | 6 | 30 |
| 2018 August | 46 | 23 | 69 |
| 2018 July | 40 | 29 | 69 |
| 2018 June | 63 | 24 | 87 |
| 2018 May | 82 | 30 | 112 |
| 2018 April | 54 | 41 | 95 |
| 2018 March | 80 | 34 | 114 |
| 2018 February | 43 | 9 | 52 |
| 2018 January | 68 | 13 | 81 |
| 2017 December | 72 | 14 | 86 |
| 2017 November | 54 | 21 | 75 |
| 2017 October | 21 | 17 | 38 |
| 2017 September | 25 | 14 | 39 |
| 2017 August | 14 | 12 | 26 |
| 2017 July | 11 | 6 | 17 |
| 2017 June | 23 | 17 | 40 |
| 2017 May | 30 | 8 | 38 |
| 2017 April | 6 | 2 | 8 |
| 2017 March | 12 | 2 | 14 |
| 2017 February | 7 | 3 | 10 |
| 2017 January | 12 | 3 | 15 |
| 2016 December | 10 | 4 | 14 |
| 2016 November | 8 | 6 | 14 |
| 2016 October | 9 | 9 | 18 |
| 2016 September | 5 | 6 | 11 |
| 2016 August | 5 | 2 | 7 |
| 2016 July | 3 | 1 | 4 |
| 2016 May | 0 | 5 | 5 |
| 2016 April | 2 | 5 | 7 |
| 2016 March | 5 | 17 | 22 |
| 2016 February | 9 | 9 | 18 |
| 2016 January | 7 | 6 | 13 |
| 2015 December | 10 | 3 | 13 |
| 2015 November | 3 | 3 | 6 |
| 2015 October | 2 | 3 | 5 |
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