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7/24/2019 Bronsiectaziile 150404021911 Conversion Gate01
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BRONSIECTAZIILE
GHID DE PRACTICA SPITAL PNF BACAU
Adaptat dupa BTSguidelines
DEFINITIE:dilatatia anormala si ireersi!ila a "na sa" a mai m"ltor !ron#ii $"
in%lamatie $roni$a a $ailor aeriene&Se aso$ia'a (rod"$tia $roni$a de s("ta)in%e$tiire$"rente res(iratorii si o!str"$tie $ai aeriene&
ASPECTE CLINICE :s"s(e$tam !ronsie$ta'iile la (a$ientii $" e(isoade re$"rente de
!ronsita de*a l"n+"l anilor anterior (re'entarii la medi$&
CAUZE
BRONCHIECTASIS
Bron$#olit#
Retra$tion o% (aren$#ima
O!str"$tion !, %orei+n !od,Neo(lasti$ o!str"$tion
Cartila+e de%i$ien$,
Cilia s,ndrome
Host de%enses do-n.a+amma+lo!"linemia/
In%e$tion
Em(#,sema
C,sti$ %i!rosis
C#roni$ +ran"lomato"s disease
T"!er$"losis
ABPA
S-,er*0ames s,ndrome
In#alation in1"r,.ammonia)+astri$ a$id/
Sar$oidosis
CLASIFICARE:
USOARE*CILINDRICE
2ODERATE*3ARICOASE
SE3ERE*SACULARE.CHISTICE/
TABLOU CLINIC :
SI2PTO2E :
T"se
Prod"$tie $roni$a de s("ta ("r"lenta si 'ilni$a
Hemo(ti'ii intermitente
Dis(nee
D"rere (le"rala intermitenta."'"al aso$iata $" in%e$tie/
Letar+ie
SE2NE :Ral"ri !ronsi$e
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4#ee'in+
DIAGNOSTIC :s"s(i$i"ne $lini$a $on%irmata de CT tora$i$a
IN3ESTIGATII :
E5amen san+e.le"$o$ite si %orm"la le"$o$itara)3SH)CRP/*$a semne nes(e$i%i$ede !oala a$tia si de eal"are seeritate e5a$er!are
Radio+ra%ia ("lmonara standard
E5 CT .HRCT/tora$i$
E5 !a$teriolo+i$ 6s("ta :mi$ros$o(ie)$"lt"ra)anti!io+rama
S(irometrie 7test de !ron#odilatatie
IN3ESTIGATII SUPLI2ENTARE
8& Fi!ro!ron#os$o(ia:(t a e5$l"de "n $or( strain.in $a' de s"s(i$i"ne
CT/sa" (t re$oltare s("ta)in $a' de ese$ al tera(iei anti!ioti$e initiale
9& Tran'it !aritat .eso%a+ian/in $a' de s"s(i$i"ne de as(iratie re$"renta
Or+anisme i'olate in !ronsie$ta'ii :
8& Haemo(#il"s in%l"en'ae 8*;*;8=
;& Sta%ilo$o$"l a"ri" ?*8=& Stre(to$o$"s (ne"moniae 9*8;=
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S$aderea tolerantei la e%%ort
S$aderea %"n$tiei ("lmonare.8?=/
2odi%i$ari radiolo+i$e $are indi$a "n (ro$es a$"t
Im(ortant*istori$ %lora mi$ro!iana*(a$ient
CRITERII INTERNARE* EACERBARI
Pre'enta $iano'ei si a $on%"'iei
In$a(a$itatea de a se trata la domi$ili"
Dis(nee $" (oli(nee*9
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ALGORIT2 PT TERAPIA ANTIBIOTICA IN BRONSIECTAZII
SPUTA DE FOND:
SPUTA 2UCOIDA2UCOPURULENTA******E5a$er!are****Anti!ioti$ tintit 8'ile
SPUTA se de$olorea'a ****dar re$adere imediata*******se $onsidera tera(ie
(ro%ila$ti$atera(ie de l"n+a d"rata
SPUTA se de$olorea'a dar %re$ente e5a$er!ari;an****se $onsidera tera(ie
(ro%ila$ti$atera(ie de l"n+a d"rata
SPUTA se de$olorea'a***e5a$er!ari rare*******se tratea'a %ie$are e5a$er!are $"
anti!ioti$"l (otriit
SPUTA PURULENTA******E5a$er!are*****do'a inalta de anti!ioti$*****s("ta se
de$olorea'a dar re$adere imediata*****tera(ie de l"n+a d"rata $" anti!ioti$e
.ne!"li'are/
PACIENTUL CU EACERBARE ACUTA :
Tratament (rom(t $" anti!ioti$ in %"n$tie de $#imiore'istenta lo$ala
D"rata* 8 'ile si $el ("tin 9 'ile d"(a $lari%i$area s("tei
Do'a inalta se da in %"n$tie de 1"de$ata $lini$a si starea de %ond a (a$ient"l"i.intre
e5a$er!ari/la $ei $" s("ta ("r"lenta si intre e5a$er!ari
****la $ei $are es"ea'a tratament"l in do'e $onentionale dar +ermen"l
este sensi!il la anti!ioti$"l res(e$ti
Da$a s("ta n" se $lari%i$a.sa deina m"$oida/ sa" re$aderea este ra(ida.in 'ile/ se
$onsidera tera(ie de l"n+a d"rata&
Tratament"l se reede la $$a 'ile la (a$ientii $are a" tendinta la ese$ si s("ta ramane
("r"lenta
ANTIBIOTICE
8& Beta la$tama'a7 mi$roor+anisme.2ora5ella)H in%l"en'ae/***AUG2ENTIN*8+
de9* ; ori'i .ioral/
9& Pne"mo$o$"l si H in%l"en'ae !eta la$tama'a ne+AUG2ENTIN*@9
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Pa$ientii (ot aea neoie de tera(ie i&& Se (ot %olosi : CEFTAZIDI2)
PIPERACILINA7TAZOBACTA2)2ERONE2&Poate %i $om!inata $"
GENTA2ICINA)TOBRA2ICINA) Colistin
TERAPIA DE LUNGA DURATA
Tera(ia anti!ioti$a de l"n+a d"rata %ie (e $ale orala %ie (e $ale in#alatorie.ne!"li'are/
este de l"at in seama la (a$ientii $are e5a$er!ea'a %re$ent. ; e5a$er!arian/ sa" a" o
stare +enerala (re$ara $onstanta datorita !olii&
A Tera(ia (e $ale orala 6e%e$t %aora!il mai ales as"(ra sim(tomelor si mai ("tin as"(ra
%re$entei e5a$er!arilor sa" as"(ra %"n$tiei ("lmonare&
** se da in do'e mai mi$i de$at do'ele standard %olosite in
tratament"l e5a$er!arilor )tinand $ont de anti!io+rama.(r"denta la %olosire/
**%olosirea i"nolonelor sin+"re (e termen l"n+ n" se "tili'ea'a
.ris$ de re'istenta la (a$ientii $" Pse"domonas aer"+inosa/
B Tera(ia de l"n+a d"rata (e $ale in#alatorie.ne!"li'are/ l"ata in $onsiderare la
(a$ientii $"; e5a$er!arian $are ne$esita anti!ioti$otera(ie sa" la (a$ientii $are a"
e5a$er!ari mai ("tine dar $are $a"'ea'a o mor!iditate semni%i$atia
l"ata in $onsiderare la (a$ientii $roni$ $oloni'ati $" P&aer"+inosa)(re'entand
ris$"ri sistemi$e m"lt mai s$a'"te&
Se %a$e anti!io+rama inainte de in$e(erea tratament"l"i&
Se "tili'ea'a :Colistin)To!rami$ina).(t P aer"+inosa/Gentami$ina&
RECO2ANDARI SUPLI2ENTARE :
Tratament"l em(iri$ tre!"ie in$e("t inainte de a aea re'"ltatele !a$teriolo+i$e ale
s("tei&
D"rata standard de tratament este de 8 'ile&
Da$a n" aem "n istori$ !a$teriolo+i$)tratament"l de (rima intentie este $"
A"+mentinAmo5i$ilina*8 'ile sa" Claritromi$ina 8 'ile in $a' de Peni$ilinre'istenta.!etala$tamine/&
Tratament"l i ar tre!"i in$e("t la (a$ientii $" stare +enerala alterata)la $ei la $are
tera(ia orala a es"at sa" la $ei $" mi$roor+anisme re'istente&
Com!inatiile de anti!ioti$e n" s"nt ne$esare la (a$ientii $oloni'ati $"
H&in%l"en'ae)2&$atarr#alis)S&(ne"monis)Sta%ilo$o$"l a"ri" meti$ilin sensi!il&
Da$a s"nt mai m"lt de "n +ermen ar tre!"i administrat "n anti!ioti$ $are sa*i a$o(ere
(e amandoi&Da$a n" este %e'a!il) se or administra 9 anti!ioti$e&
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La (a$ientii la $are tratament"l oral $" Ci(ro%lo5a$in n" a %ost %aora!il)administrarea
"n"i anti!ioti$.monotera(ie/ i anti(se"domonas )tre!"ie l"ata in $onsideratie&
Com!inatiile de anti!ioti$e ar tre!"i sa %ie "tili'ate (entr" in%e$tii $" Pse"domonas
aer"+inosa $are s"nt re'istente la "n"l sa" mai m"lte anti!ioti$e
anti(se"domonas.in$l"si Ci(ro%lo5a$ina/ sa" da$a medi$"l $onsidera $a ar aea neoiede $"re se$entiale de anti!ioti$e (entr" a red"$e $#imiore'istenta&
2RSA ar tre!"i tratata $" do"a anti!ioti$e orale sa" "n sin+"r anti!ioti$ intraenos&
TERAPIA PROFILACTICA
2a$rolide*(ro(rietati im"nomod"latoare
*in#i!a %ormarea !io%ilm"l"i
A'it#rom,$in : 9
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E3ALUARE TRATA2ENT
S$aderea de ol"m a s("tei
S$#im!area $ara$ter"l"i s("tei din ("r"lentm"$o("r"lent in m"$os
Ameliorarea s(irometriei si a semnelor +enerale
INDICATIA CHIRURGICALA
Sim(tome seere neameliorate de tratament"l medi$amentos "'"al
A!$es"l ("lmonar
Hemo(ti'ii massie
S$oaterea "n"i se+ment sa" lo! a %i $onsiderate mai ales da$a o!str"$tia este
(ro5imala si d"$e la !oala distala
Bronsie$ta'ia tre!"ie sa %ie lo$ali'ata
CO2PLICATII
E5a$er!ari in%e$tioase
Hemo(ti'ie
Pne"motora5
Ins"%i$ienta res(iratorie
Amiloido'a
Hemo(ti'ia*mai ales in tim("l e5a$er!arilor
*masia9
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Tera(ie de l"n+a d"rata $" "n amino+li$osid in ne!"li'are (t s$aderea in$ar$arii $"
(se"domonas&
TERAPIA INHALATORIE :
in l"$r"
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