O desenvolvimento comportamental de um recém-nascido a termo é influenciado pelas experiências sensoriais durante a vida pós-uterina. No caso de crianças nascidas pré-termo, essas experiências são prejudicadas, uma vez que as abordagens realizadas em um ambiente de terapia intensiva ou semi-intensiva não são favoráveis ao desenvolvimento. O posicionamento em ninho é uma estratégia de cuidado desenvolvimental capaz de reduzir os efeitos deletérios dos ambientes nocivos das unidades de terapia intensiva e semi-intensiva, auxiliando em um melhor desenvolvimento do recém-nascido. O objetivo do estudo foi comparar os efeitos do posicionamento em ninho nos decúbitos dorsal (DD) e lateral direito (DLD) em relação aos estados de sono e vigília, frequência cardíaca (FC) e saturação periférica de oxigênio (SpO2) em recém-nascidos pré-termo. Trata-se de um ensaio clinico randomizado, controlado e cruzado (crossover), composto por 30 recém-nascidos pré- termo, saudáveis, com idade pós-conceptual >= 32 semanas e idade pós-natal > 24 horas no dia da intervenção, de ambos os sexos, internados em Unidade de Cuidados Intermediários Neonatais do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, São Paulo, Brasil. A intervenção foi realizada mediante posicionamento dos recém-nascidos nos decúbitos dorsal e lateral direito, sendo randomizados em dois grupos, de acordo com a ordem de posicionamento nos decúbitos por meio de sorteio. Permaneceram por 30 minutos em cada postura e neste período foram coletados indicadores comportamentais e fisiológicos. Nos resultados, o DLD favoreceu a maior permanência em sono ativo, em valores absolutos, enquanto que o DD favoreceu a permanência em alerta ativo quieto. Quanto às variáveis fisiológicas, a SpO2 foi menor no DLD comparado ao DD, porém, sem relevância clínica. Não houve diferença estatística quanto à FC. Concluímos que ambos os posicionamentos favoreceram a menor ativação comportamental, porém o DLD manteve os lactentes em maior permanência nos estados de sono em relação ao DD, em valores absolutos / The behavioral development of a newborn at term is influenced by sensory experiences during intrauterine life. In the case of children born preterm, these experiences are harmed, since the approaches taken in an environment of intensive or semi-intensive therapy are not favorable to development. The positioning in nest is a developmental care strategy able to reduce the deleterious effects of harmful providing a better development of the newborn. The objective of this study was to compare the effects of positioning in nest in the dorsal (DP) and right lateral position (RLP) in relation to the states of sleep and wakefulness, cardiac frequency and peripheral oxygen saturation in pre-term newborns. This is a randomized clinical trial, controlled crossover study, composed of 30 preterm newborns, healthy, with postconceptional age >= 32 weeks and postnatal age > 24 hours in the day of the intervention, of both sexes, hospitalized in the neonatal intermediate care unit of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, São Paulo, Brazil. The intervention was performed by positioning the newborns in the dorsal and right lateral positions, being randomized in two groups, according to the order of positioning in the decubitus by means of a draw. They remained for 30 minutes in each posture and during this period were collected behavioral and physiological indicators. In the results, the RLD favored a greater permanence in active sleep, in absolute values, while DP favored permanence in the active alert quiet. Regarding physiological variables, the peripheral oxygen saturation was lower in the RLD compared to DP, but without clinical relevance. There was no statistical difference regarding the cardiac frequency. We conclude that both positions have favored lower behavioral activation, however RDL kept infants in greater permanence in the states of sleep in relation to the DD, in absolute values

Pacientes críticos hospitalizados têm risco elevado para desenvolver úlcera de pressão (UP), a qual muitas vezes é considerada como uma iatrogenia. Assim, estudos de prevalência são necessários para identificar a situação inicial do hospital para estabelecer um plano de ação. Para alcançar esta meta, este estudo foi realizado de forma retrospectiva em um hospital universitário de Minas Gerais. Os prontuários de 234 pacientes críticos foram revisados após a aprovação do Comitê de Ética em Pesquisa da instituição. Foram considerados pacientes críticos aqueles que estiveram internados no Centro de Terapia Intensiva (CTI). Os dados coletados foram referentes a todo o período de hospitalização, incluindo o tempo anterior e posterior à CTI. A maior parte dos pacientes era do sexo masculino (61,5%), brancos (65,4%), e as doenças mais freqüentes foram referentes ao sistema circulatório (37,6%). Grande parte tinha idade entre 21 e 49 anos (36,8%), e 32,5% tinham mais que 65 anos. O coeficiente de prevalência de UP foi de 25,6%. Dos 60 pacientes com UP, 30,0% apresentaram a UP antes da admissão no CTI, 55,0% durante a internação no CTI e 10% após sair do CTI. O tempo médio de hospitalização foi de 21,2 dias (DP 19,7). O tempo médio de hospitalização no CTI foi de 8,6 dias (DP 14,8). Cento e cinco pacientes (44,9%) foram a óbito durante a hospitalização, demonstrando a gravidade das condições de saúde desta população. O teste do Qui-Quadrado identificou presença de associação (α=0,05) entre a UP e idade maior ou igual a 65 anos, maior tempo de hospitalização e saída do hospital por óbito. São feitas recomendações para que se utilize a Escala de Braden para auxiliar o profissional enfermeiro na identificação dos pacientes que apresentam risco para desenvolver UP para seleção das medidas preventivas. / Hospitalized critical patients have a high risk of developing pressure ulcers (PU), which are many times considered iatrogeny. Therefore, there is a need for prevalence studies in order to identify the initial situation in the hospital to then establish an action plan for intervention. To reach this goal, this study was accomplished in a retrospective way at a university hospital in Minas Gerais State. A total of 234 critical patients' records were reviewed after the approval by the institution’s Research Ethics Committee. Patients were considered critical if they had been hospitalized in the Intensive Therapy Unit (ITU). The collected data referred to the whole hospitalization period, including the previous and subsequent time at ITU. Most patients were male (61.5%) and white (65.4%), and the most frequent diseases were those related to the circulatory system (37.6%). Most were aged between 21 and 49 years old (36.8%), and 32.5% were aged over 65 years. The PU prevalence was 25.6%. From the 60 patients with PU, 30.0% had presented PU before the admission at the ITU, 55.0% during the hospitalization at the ITU, and 10% after leaving the ITU. The mean time of hospitalization was 21.17 days (DP 19.67). The mean time of hospitalization in ITU was 8.62 days (DP 14.78). From the total of patients, 105 (44.9%) died during the hospitalization, demonstrating the severity of this population’s health conditions. The Chi-Square Test identified the presence of an association (α=0,05) between PU and age equal or over 65 years of age. The longer the patient stayed in the hospital, the higher the probability of death. There are recommendations for the use of Braden’s Scale to help the professional nurse in the identification of patients that present risks of developing PU. Such preventive measures contribute to a better quality of life, lower costs, and more efficiency to the professional’s work.

The purpose of this thesis was to quantify the cost of care and treatment of pressure ulcers in Thomayer University Hospital with polyclinic (FTNsP) in Prague. Present pressure ulcer monitoring system was analyzed and a transformation of the records collected by this systém in the period 2005 - 2010 was performed in order to derive the necessary data - especially the number of patient-days, displayed by severity of the pressure ulcers. Data on expenditure of materials and pharmaceuticals was obtained by questionnaire survey, conducted in 2009 among the nursing staff. The description of the incidence of pressure ulcers in FTNsP, analysis of the effect of the use of anti-decubitus mattress on the incidence of pressure ulcers and bedsores costs per patient and for the entire hospital according to a single component of direct costs and costs of extended hospital stay are the results of the thesis.

A pesquisa tem como objetivos identificar e analisar a incidência de úlcera de pressão (UP), identificar os fatores de risco a ela relacionados e investigar a validade preditiva da escala de Braden, numa amostra de 53 pacientes internados no Centro de Terapia Intensiva (CTI) de um hospital universitário do interior paulista, durante 3 meses consecutivos. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Intituição. Os dados foram coletados pelo exame físico dos pacientes, na avaliação do risco na escala de Braden, entrevistas com os pacientes e/ou familiares e revisão dos prontuário. As avaliações foram realizadas até 24 horas após a admissão, 48 horas após a admissão e, posteriormente, em dias alternados até à detecção da presença de úlcera, de alta ou óbito do paciente. Vinte pacientes desenvolveram 59 úlceras no período, acarretando uma incidência de 37%. As localizações mais comuns foram a região dos calcâneos (42,4%), sacrococcígea (30,5%) e glúteos (11,8%). Houve predomínio de úlceras no estágio I (59,3%) não sendo observadas úlceras em estágio IV. Nas seis primeiras avaliações os pacientes com úlcera de pressão obtiveram escores menores na escala de Braden que os sem Up, com diferença estatisticamente significante entre os grupos. Os escores das subescalas percepção sensorial, atividade, mobilidade, fricção e cisalhamento foram na maioria das avaliações menores para os pacientes com UP com diferença estatisticamente significantes, o que não ocorreu nas sub-escalas umidade e nutrição. Dentre outros fatores investigados, a respiração controlada por aparelho e saída por alta e óbito apresentaram relacionamento com presença de úlcera de pressão. Houve diferença estatisticamente significante entre o tempo de internação hospitalar e no CTI, entre os grupos, sendo esses superiores para os pacientes com UP. Os resultados dos testes para investigar a validade preditiva da escala de Braden apontaram que, na primeira avaliação, o escore 14 obteve elevada sensibilidade e validade preditiva para teste negativo, porém, a especificidade e validade preditiva para teste positivo foram inferiores. Na segunda e terceira avaliação, a escala demonstrou um melhor desempenho nos testes de validação para os escores 13 e 12, respectivamente. / The research had as objectives to identify and analyze pressure ulcer incidence, to identify related risk factors and investigating the predictive validity of the Braden scale in a sample of 53 patients hospitalized in an Intensive Care Center (ICC) of an university hospital during 3 months. The study was approved by the institution Ethical Research Committee. Data were collected by physical examination, by the application of the Braden scale, patient and family member interviews and by review of patient records. Evaluation were done within 24 hours of admission at the ICC, 48 hours after that and subsequently every other day until the observation of pressure ulcer development, hospital discharge or death of patient. Twenty patients developed 59 pressure ulcers, an index of incidence of 37.7%. The ulcers were located predominantly on heels (42.4%), sacral and coccyx region (30.5%) (30.5%) and buttocks (11.8%). Most of ulcers were on stage I (59.3%) and there was no ulcer on stage IV. On the six first evaluations, patients with pressure ulcers had lower scores in Braden scale than patients without pressure ulcers with significant statistical differences between groups. Scores of sub-scales of sensory perception, activity, mobility, friction and shear were in most of evaluation lower to patients with pressure ulcer with significant statistical differences between groups what did not occur to the sub-scales moisture and nutrition. Among other factors that were investigated, use of mechanical respiration and leaving the ICC because of hospital discharge or death were related to having a pressure ulcer. There were significant differences related to length of hospitalization and length of permanence on ICC between groups when for patients with pressure ulcer both were longer. The results of the tests to investigate the predictive validity of the Braden scale showed that on the first evaluation the score 14 was a score that had a high sensitivity and predictive validity for a negative test however the specificity and predictive validity for a positive test were lower. On the second and third evaluation the scale showed a better performance on predictive validity tests for the 13 and 12 scores respectively.

A pesquisa tem como objetivos identificar e analisar a incidência de úlcera de pressão (UP), identificar os fatores de risco a ela relacionados e investigar a validade preditiva da escala de Braden, numa amostra de 53 pacientes internados no Centro de Terapia Intensiva (CTI) de um hospital universitário do interior paulista, durante 3 meses consecutivos. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Intituição. Os dados foram coletados pelo exame físico dos pacientes, na avaliação do risco na escala de Braden, entrevistas com os pacientes e/ou familiares e revisão dos prontuário. As avaliações foram realizadas até 24 horas após a admissão, 48 horas após a admissão e, posteriormente, em dias alternados até à detecção da presença de úlcera, de alta ou óbito do paciente. Vinte pacientes desenvolveram 59 úlceras no período, acarretando uma incidência de 37%. As localizações mais comuns foram a região dos calcâneos (42,4%), sacrococcígea (30,5%) e glúteos (11,8%). Houve predomínio de úlceras no estágio I (59,3%) não sendo observadas úlceras em estágio IV. Nas seis primeiras avaliações os pacientes com úlcera de pressão obtiveram escores menores na escala de Braden que os sem Up, com diferença estatisticamente significante entre os grupos. Os escores das subescalas percepção sensorial, atividade, mobilidade, fricção e cisalhamento foram na maioria das avaliações menores para os pacientes com UP com diferença estatisticamente significantes, o que não ocorreu nas sub-escalas umidade e nutrição. Dentre outros fatores investigados, a respiração controlada por aparelho e saída por alta e óbito apresentaram relacionamento com presença de úlcera de pressão. Houve diferença estatisticamente significante entre o tempo de internação hospitalar e no CTI, entre os grupos, sendo esses superiores para os pacientes com UP. Os resultados dos testes para investigar a validade preditiva da escala de Braden apontaram que, na primeira avaliação, o escore 14 obteve elevada sensibilidade e validade preditiva para teste negativo, porém, a especificidade e validade preditiva para teste positivo foram inferiores. Na segunda e terceira avaliação, a escala demonstrou um melhor desempenho nos testes de validação para os escores 13 e 12, respectivamente. / The research had as objectives to identify and analyze pressure ulcer incidence, to identify related risk factors and investigating the predictive validity of the Braden scale in a sample of 53 patients hospitalized in an Intensive Care Center (ICC) of an university hospital during 3 months. The study was approved by the institution Ethical Research Committee. Data were collected by physical examination, by the application of the Braden scale, patient and family member interviews and by review of patient records. Evaluation were done within 24 hours of admission at the ICC, 48 hours after that and subsequently every other day until the observation of pressure ulcer development, hospital discharge or death of patient. Twenty patients developed 59 pressure ulcers, an index of incidence of 37.7%. The ulcers were located predominantly on heels (42.4%), sacral and coccyx region (30.5%) (30.5%) and buttocks (11.8%). Most of ulcers were on stage I (59.3%) and there was no ulcer on stage IV. On the six first evaluations, patients with pressure ulcers had lower scores in Braden scale than patients without pressure ulcers with significant statistical differences between groups. Scores of sub-scales of sensory perception, activity, mobility, friction and shear were in most of evaluation lower to patients with pressure ulcer with significant statistical differences between groups what did not occur to the sub-scales moisture and nutrition. Among other factors that were investigated, use of mechanical respiration and leaving the ICC because of hospital discharge or death were related to having a pressure ulcer. There were significant differences related to length of hospitalization and length of permanence on ICC between groups when for patients with pressure ulcer both were longer. The results of the tests to investigate the predictive validity of the Braden scale showed that on the first evaluation the score 14 was a score that had a high sensitivity and predictive validity for a negative test however the specificity and predictive validity for a positive test were lower. On the second and third evaluation the scale showed a better performance on predictive validity tests for the 13 and 12 scores respectively.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-02-01T17:28:07Z No. of bitstreams: 1 Simone Pereira Machado.pdf: 1367983 bytes, checksum: fd2a7468a392e8e74add7bfb2fc3cb6b (MD5) / Made available in DSpace on 2016-02-01T17:28:07Z (GMT). No. of bitstreams: 1 Simone Pereira Machado.pdf: 1367983 bytes, checksum: fd2a7468a392e8e74add7bfb2fc3cb6b (MD5) Previous issue date: 2006 / Hospital de Clínicas Niterói - ESHO/AMIL / Mestrado Profissional em Enfermagem Assistencial / Este estudo trata da efetividade das escalas de Braden e Cubbin & Jackson em pacientes de terapia intensiva. Os objetivos foram aplicar as escalas, comparar sensibilidade e especificidade e, discutir sua aplicação como estratégia preventiva para minimizar o desenvolvimento de úlceras. É uma pesquisa prospectiva, quantitativa, realizada em três unidades de terapia intensiva. A coleta dos dados foi feita no período de junho a agosto de 2005, com 39 pacientes, utilizando formulários e as próprias escalas. Os dados foram armazenados em planilha do Microsoft Excel, sendo calculadas a sensibilidade e a especificidade das 2 escalas e montadas tabelas de contingência, bem como valores preditivos positivos e negativos. Os resultados apontam que as duas escalas apresentaram boa sensibilidade, sendo a escala de Braden mais sensível (0,93) que e a Cubbin & Jackson (0,75). Por outro lado a escala de Cubbin & Jackson mostrou uma maior especificidade (0,83) que a de da Braden (0,47). Ao considerarmos os dois fatores, a escala de Cubbin & Jackson se mostra mais adequada aos pacientes da UTI, pois a soma de sua sensibilidade e especificidade é 1,58 contra 1,40 da escala de Braden. Conclui-se que as duas escalas mostraram-se efetivas, sendo que a de Cubbin & Jackson é mais indicada uma vez que é mais especifica, apresentando menos falso-positivos. O presente estudo contribuirá para o planejamento do cuidado a pacientes criticamente enfermos, com a mobilidade comprometida, em risco de úlcera de decúbito, resultando na implementação de ações rápidas e eficazes para a prevenção da mesma / This study is about the effectiveness of the scales of Braden and Cubbin & Jackson in patients of intensive therapy. The objectives were to apply the scales, to compare sensibility and specificity and to discuss their application as a preventive strategy to minimize the development of ulcers. It is a prospective, quantitative research, which was accomplished in three units of intensive therapy. The collection of the data was made with 39 patients in the period of June to August of 2005, with which we used formularies and the scales mentioned previously. The data were stored in spreadsheet of Microsoft Excel, with which the sensibility and the specificity of the 2 scales were calculated and contingency tables were mounted, as well positive and negative preditive values. The results point that the two scales presented good sensibility, with the scale of Braden being more sensitive (0,93) than the Cubbin & Jackson’s (0,75). On the other hand, the scale of Cubbin & Jackson showed a larger specificity (0,83) than the Braden’s one (0,47). If we consider the two factors, the scale of Cubbin & Jackson is shown to be more appropriate to the patients of ICU because the sum of its sensibility and specificity is 1,58 against 1,40 for the scale of Braden. We concluded that the two scales have shown to be effective, and Cubbin & Jackson’s is more suitable, once it is more specific and presents less false-positive cases. The present study will contribute to the planning of caring with the patient in a critical stage of sickness, with committed mobility and in risk of pressure ulcer, resulting in the implementation of fast and effective actions for its prevention

Bakgrund. I omvårdnaden ska distriktssköterskan se till människans hela situation och omvårdnaden ska utföras på ett personcentrerat och säkert sätt. I hemsjukvården utförs vården i patientens hem, antingen i ordinärt eller särskilt boende. Trycksår är en vanlig vårdskada och nutritionen är viktig för att förebygga och behandla trycksår. Syftet var att beskriva i vilken utsträckning som distriktssköterskor i hemsjukvården använder nutritionsåtgärder som trycksårsbehandling. Metod. För att besvara syftet användes en kvantitativ design där redan insamlad data från en trycksårsmätning togs del av. Resultatet visade att nutritionsåtgärder användes som trycksårsbehandling till 65% av patienterna. Bland varannan distriktssköterska som inte använde nutritionsåtgärder framkom olika orsaker. Det var vanligare att nutritionsåtgärder användes vid risk enligt riskbedömningarna MNS och SF-MNA. De vanligast använda nutritionsåtgärderna var näringsdryck och extra mellanmål. Resultatet visade att det fanns skillnader i trycksårens svårighetsgrad i förhållande till boendeform. Slutsats. Det fanns utrymme för förbättringar i att använda nutritionsåtgärder vid trycksår. Nutritionen spelar en betydelsefull roll i behandlingen av trycksår och det är viktigt att riskbedömningar utförs. Genom att tidigt använda nutritionsåtgärder som trycksårsbehandling kan distriktssköterskan främja hälsa, förebygga sjukdom och skada samt minska patientens lidande. / Background. In Nursing Care, it's important to see to the whole perspective of the patient, and the care should be performed in a person-centred and safe way. The purpose was to describe district nurses [DN] using of nutrition therapy as treatment for patients with pressure ulcers in home healthcare. Method. A quantitative design, where material from an already collected pressure ulcer study, was used. The result showed that nutritional therapy was used as pressure ulcer treatment in 65% of the patients. Among every other DN who did not use nutritional therapy as treatment of pressure ulcer, various causes were identified. It was more common to use nutritional therapy when risks according to MNS and SF-MNA assessments were found. The most common nutrition therapies were nutritional drinks and extra snacks. The result showed that there were differences in the severity of pressure ulcers in relation to patients' housing type. Conclusion. There was room for improvements in using nutrition therapy as pressure ulcer treatment. Nutrition plays an important role in the prevention and treatment of pressure ulcer, and it's important that risk assessments are performed. By initiating nutritional treatment early, the DN can promote health, prevent disease and injury, and reduce the patient's suffering.

BACKGROUND Cardiac surgery patients have some of the highest reported incidence and prevalence of pressure injuries (PI). A growing subset of cardiac surgery include patients with end-stage heart failure who undergo ventricular assist device (VAD) or total artificial heart (TAH) surgery. The risk of PI and their natural history of development in this population are unknown and the specific risk factors for PI development remain unexplored. OBJECTIVES To perform a systematic review of the literature to identify the incidence and risk factors of PI development in patients undergoing VAD-TAH surgery and thereby inform study design and variables in an eight-year retrospective study of all patients undergoing VAD-TAH surgery at a large academic university medical center. METHODS The preferred reporting items for systematic reviews and meta-analyses or PRISMA statement guided this systematic review. Quality of evidence was determined using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale. Two reviewers independently appraised manuscripts matching the eligibility criteria for study inclusion. Four databases including PubMed, CINAHL, Web of Science, Google Scholar, and hand searches of journals based on reference lists from included studies were utilized. Initial results of this primary search revealed zero studies that met inclusion and this search methodology was confirmed by medical librarian consultation. Therefore, a follow up retrospective study was necessary to identify incidence of PI in the VAD-TAH population. However, a secondary search, dropping keywords of VAD-TAH and instead focusing on studies of on-pump cardiac surgery and mixed surgical studies where cardiac surgery patients were included, was conducted to establish variables to guide a retrospective study of all VAD-TAH surgeries between 2010-2018. The retrospective study evaluated the incidence of pressure ulcers by case, patient and incidence density for each of the respective 1000 patient days during the study period. Univariate statistics are reported by four different VAD-TAH devices. Variables significant in bivariate analysis were entered in a stepwise logistic regression model. RESULTS In the systematic review, 312 articles were identified from the databases with eight additional articles from hand searches. Following abstract review, 208 were excluded for not meeting inclusion criteria or study quality metrics. 77 articles were read in full, with 61 excluded, leaving 16 articles for inclusion. 31 risk factors were identified for PI development in on-pump cardiac surgery patients with 11 risk factors which were identified as significant in multivariate analysis for inclusion in the retrospective study.

Introduction: La pneumonie associée à la ventilation mécanique (VM) est fréquente chez les patients ventilés. L’étirement cyclique (EC) induit par la VM pourrait amorcer le poumon vers une réponse inflammatoire en cas d'exposition à des bactéries. Les Toll-like Receptors (TLR) reconnaissent les bactéries et déclenchent l'immunité. La VM pourrait moduler l'expression des TLR et leur réactivité aux agonistes. Le décubitus ventral (DV) réduit l’étirement du poumon. Méthodes: Les niveaux de TLR2 et la réponse à ses agonistes ont été mesures dans des cellules pulmonaires soumises à un EC, et dans un modèle de lapin ventilé. Une stimulation ex vivo du sang total prélevé sur lapins ventilés a été réalisée. Une pneumonie a été induite chez des lapins soumis à VM et maintenus en décubitus dorsal ou tournés en DV. Résultats: L’EC des cellules ainsi que des poumons de lapins augmente les niveaux de TLR2 et la réponse inflammatoire à ses agonistes. La VM et l’exposition du poumon à des agonistes TLR2 induisent synergiquement des lésions. Chez des lapins avec pneumonie sous VM la clairance bactérienne pulmonaire est réduite, la probabilité de bactériémie et le taux des cytokines circulantes augmentés. Le sang total provenant d'animaux sous VM libère de grandes quantités de cytokines après stimulation. Le DV est associe à des niveaux plus faibles de concentrations bactériennes et d'inflammation. Conclusions: La VM sensibilise le poumon aux ligands bactériens de TLR2, modifie la clairance bactérienne pulmonaire, favorise les lésions pulmonaires et de l'inflammation. La surexpression de TLR2 induite par l’EC pourrait expliquer ces différences. Le DV pourrait avoir un effet protecteur. / Introduction: Ventilator-associated pneumonia is common in patients subjected to mechanical ventilation (MV). Cyclic stretch subsequent to MV could prime the lung toward an inflammatory response if exposed to bacteria. Toll-like receptors (TLRs) recognize pathogens thus triggering immunity. MV could modulate TLRs expression and responsiveness to agonists. The prone position (PP) reduces lung stretch.Methods:TLR2 levels and response to the TLR2 ligands were measured in human pulmonary cells submitted to cyclic stretch, and either spontaneously breathing (SB) or MV rabbits. Ex vivo stimulation of whole blood taken from SB or MV rabbits was performed.Enterobacter aerogenes pneumonia was induced in rabbits subjected to MV and kept supine or turned to the PP. Results: Cyclic stretch of human cells as well as rabbitsÕ lung increased both TLR2 levels and inflammatory response to its agonist. MV and airways exposure to TLR2 ligands acted synergistically in causing lung injury.A decrease of lung bacterial clearance and a greater likelihood of bacteremia were observed in MV rabbits with S. aureus pneumonia. Circulating cytokines rose significantly only in these animals. MV induced TLR2 spleen overexpression. Whole blood obtained from MV animals released larger amounts of cytokines after stimulation. PP was associated with lower levels of bacterial concentrations and inflammation. Conclusions: MV sensitizes the lung to bacterial TLR2 ligands, alters lung bacterial clearance, promotes lung injury and inflammation. Both pulmonary and peripheral blood stretch-induced TLR2 overexpression could account at least in part for such differences. The PP could be protective.