MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C28063.34D09E00" This document is a Web archive file. If you are seeing this message, this means your browser or editor doesn't support Web archive files. For more information on the Web archive format, go to http://officeupdate.microsoft.com/office/webarchive.htm ------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" NEUMONIA HOSPITALARIA

Esta presentación contiene elementos que su explorador no puede mostrar correctamente. Esta versión está diseñada para utilizar versiones más modernas de Microsoft Internet Explorer.

Si desea continuar, haga clic aquí.

 ------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/master18.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"
Haga clic para cambiar el estilo de título
Haga clic para modificar el estilo de texto del patró= n
Segundo nivel
Tercer nivel
Cuarto nivel
Quinto nivel
‹fecha y hora› <= /span>
‹pie= de página›
‹N&o= rdm;› <= /span>
------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/master18.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/preview.wmf Content-Transfer-Encoding: base64 Content-Type: image/x-wmf AQAJAAADKxIAAAYAXQIAAAAABAAAAAMBCAAFAAAACwIAAAAABQAAAAwCtQDJAAMAAAAeAAcAAAD8 AgAA////AAAABAAAAC0BAAAMAAAAQAkhAPAAAAAAAAAAtADIAAAAAAAIAAAA+gIAAAAAAAAAAAAA BAAAAC0BAQAEAAAALQEAAAQAAAAnAf//AwAAAB4ABwAAAPwCAAAzM8wAAAAEAAAALQECAAwAAABA CSEA8AAAAAAAAAAMAAoAQwAGAAQAAAAtAQEABAAAAC0BAAAEAAAAJwH//wMAAAAeAAcAAAD8AgAA XFzRAAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAADAABAEMADwAEAAAALQEAAAQAAADwAQMABwAA APwCAACFhdgAAAAEAAAALQEDAAwAAABACSEA8AAAAAAAAAAMAAEAQwAQAAQAAAAtAQAABAAAAPAB AwAHAAAA/AIAALCw4wAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAwAAQBDABEABAAAAC0BAAAE AAAA8AEDAAcAAAD8AgAA09PvAAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAADAABAEMAEgAEAAAA LQEAAAQAAADwAQMABwAAAPwCAADs7PcAAAAEAAAALQEDAAwAAABACSEA8AAAAAAAAAAMAAEAQwAT AAQAAAAtAQAABAAAAPABAwAHAAAA/AIAAPr6/QAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAwA AQBDABQABAAAAC0BAAAEAAAA8AEDAAQAAAAtAQEABAAAAC0BAAAEAAAAJwH//wQAAADwAQIAAwAA AB4ABwAAAPwCAAD/zwEAAAAEAAAALQECAAwAAABACSEA8AAAAAAAAAAMAAkATgAJAAQAAAAtAQEA BAAAAC0BAAAEAAAAJwH//wMAAAAeAAcAAAD8AgAA/9E4AAAABAAAAC0BAwAMAAAAQAkhAPAAAAAA AAAADAABAE4AEQAEAAAALQEAAAQAAADwAQMABwAAAPwCAAD/1mIAAAAEAAAALQEDAAwAAABACSEA 8AAAAAAAAAAMAAEATgASAAQAAAAtAQAABAAAAPABAwAHAAAA/AIAAP/djAAAAAQAAAAtAQMADAAA AEAJIQDwAAAAAAAAAAwAAQBOABMABAAAAC0BAAAEAAAA8AEDAAcAAAD8AgAA/+e0AAAABAAAAC0B AwAMAAAAQAkhAPAAAAAAAAAADAABAE4AFAAEAAAALQEAAAQAAADwAQMABwAAAPwCAAD/8NQAAAAE AAAALQEDAAwAAABACSEA8AAAAAAAAAAMAAEATgAVAAQAAAAtAQAABAAAAPABAwAHAAAA/AIAAP/4 6wAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAwAAQBOABYABAAAAC0BAAAEAAAA8AEDAAcAAAD8 AgAA//z4AAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAADAABAE4AFwAEAAAALQEAAAQAAADwAQMA BAAAAC0BAQAEAAAALQEAAAQAAAAnAf//AwAAAB4AXQIAAEELIADMAAoACwAAAAAACgALAEwAAAAo AAAACwAAAAoAAAABAAgAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAP///wC7u/8AsLD/AKOj /wCVlf8AiIj/AHt7/wBsbP8AX1//AFFR/wBDQ/8ANTX/AMfH/wC8vP8AsbH/AKWl/wCXl/8Aior/ AHx8/wBubv8AYGD/AFJS/wBFRf8A0tL/AMnJ/wC+vv8AsrL/AKam/wCYmP8Ai4v/AH5+/wBvb/8A YWH/AFRU/wDc3P8A09P/AMrK/wC/v/8As7P/AKen/wCamv8AjIz/AH9//wBxcf8AY2P/AOTk/wDd 3f8A1NT/AMvL/wDAwP8AtbX/AKmp/wCbm/8Ajo7/AIGB/wBycv8A6+v/AOXl/wDe3v8A1dX/AMzM /wDBwf8Atrb/AKqq/wCdnf8Aj4//AIKC/wDx8f8A7Oz/AObm/wDW1v8Azc3/AMLC/wC3t/8Aq6v/ AJ6e/wCRkf8A9vb/AN/f/wDX1/8Azs7/AMPD/wC4uP8Ara3/AKCg/wD5+f8A8vL/AO3t/wDn5/8A 4OD/ANjY/wDPz/8AxcX/ALq6/wCurv8A/Pz/APr6/wDu7v8A6Oj/AOHh/wDZ2f8A0ND/AMbG/wAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAGBhTldiY2RlZmcCAFZOV1hZWltc XV5fQk5ERUZPUFFSU1RVAERFRjtHSElKS0xNADk6Ozw9Pj9AQUJD/y4vMDEyMzQ1Njc4ACMkJSYn KCkqKywtABgZGhscHR4fICEiAQ0ODxAREhMUFRYXAQIDBAUGBwgJCgsMAQQAAAAnAf//BAAAAPAB AgADAAAAHgAHAAAA/AIAABwcHAAAAAQAAAAtAQIADAAAAEAJIQDwAAAAAAAAABwAAQBAAA4ABAAA AC0BAQAEAAAALQEAAAQAAAAnAf//AwAAAB4ABwAAAPwCAAAeHh4AAAAEAAAALQEDAAwAAABACSEA 8AAAAAAAAAABAAEAVgAHAAQAAAAtAQAABAAAAPABAwAHAAAA/AIAACAgIAAAAAQAAAAtAQMADAAA AEAJIQDwAAAAAAAAAAEAAQBWAAgABAAAAC0BAAAEAAAA8AEDAAcAAAD8AgAAIiIiAAAABAAAAC0B AwAMAAAAQAkhAPAAAAAAAAAAAQABAFYACQAEAAAALQEAAAQAAADwAQMABwAAAPwCAAAkJCQAAAAE AAAALQEDAAwAAABACSEA8AAAAAAAAAABAAEAVgAKAAQAAAAtAQAABAAAAPABAwAHAAAA/AIAACYm JgAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAEAAgBWAAsABAAAAC0BAAAEAAAA8AEDAAcAAAD8 AgAAKSkpAAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAAAQABAFYADQAEAAAALQEAAAQAAADwAQMA BwAAAPwCAAArKysAAAAEAAAALQEDAAwAAABACSEA8AAAAAAAAAABAAIAVgAOAAQAAAAtAQAABAAA APABAwAHAAAA/AIAAC4uLgAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAEAAgBWABAABAAAAC0B AAAEAAAA8AEDAAcAAAD8AgAAMDAwAAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAAAQABAFYAEgAE AAAALQEAAAQAAADwAQMABwAAAPwCAAAyMjIAAAAEAAAALQEDAAwAAABACSEA8AAAAAAAAAABAAEA VgATAAQAAAAtAQAABAAAAPABAwAHAAAA/AIAADQ0NAAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAA AAEAAgBWABQABAAAAC0BAAAEAAAA8AEDAAcAAAD8AgAANzc3AAAABAAAAC0BAwAMAAAAQAkhAPAA AAAAAAAAAQABAFYAFgAEAAAALQEAAAQAAADwAQMABwAAAPwCAAA5OTkAAAAEAAAALQEDAAwAAABA CSEA8AAAAAAAAAABAAIAVgAXAAQAAAAtAQAABAAAAPABAwAHAAAA/AIAADw8PAAAAAQAAAAtAQMA DAAAAEAJIQDwAAAAAAAAAAEAAQBWABkABAAAAC0BAAAEAAAA8AEDAAcAAAD8AgAAPj4+AAAABAAA AC0BAwAMAAAAQAkhAPAAAAAAAAAAAQACAFYAGgAEAAAALQEAAAQAAADwAQMABwAAAPwCAABBQUEA AAAEAAAALQEDAAwAAABACSEA8AAAAAAAAAABAAEAVgAcAAQAAAAtAQAABAAAAPABAwAHAAAA/AIA AENDQwAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAEAAgBWAB0ABAAAAC0BAAAEAAAA8AEDAAcA AAD8AgAARkZGAAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAAAQACAFYAHwAEAAAALQEAAAQAAADw AQMABwAAAPwCAABJSUkAAAAEAAAALQEDAAwAAABACSEA8AAAAAAAAAABAAIAVgAhAAQAAAAtAQAA BAAAAPABAwAHAAAA/AIAAExMTAAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAEAAQBWACMABAAA AC0BAAAEAAAA8AEDAAcAAAD8AgAATk5OAAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAAAQACAFYA JAAEAAAALQEAAAQAAADwAQMABwAAAPwCAABRUVEAAAAEAAAALQEDAAwAAABACSEA8AAAAAAAAAAB AAEAVgAmAAQAAAAtAQAABAAAAPABAwAHAAAA/AIAAFNTUwAAAAQAAAAtAQMADAAAAEAJIQDwAAAA AAAAAAEAAgBWACcABAAAAC0BAAAEAAAA8AEDAAcAAAD8AgAAVlZWAAAABAAAAC0BAwAMAAAAQAkh APAAAAAAAAAAAQABAFYAKQAEAAAALQEAAAQAAADwAQMABwAAAPwCAABYWFgAAAAEAAAALQEDAAwA AABACSEA8AAAAAAAAAABAAIAVgAqAAQAAAAtAQAABAAAAPABAwAHAAAA/AIAAFtbWwAAAAQAAAAt AQMADAAAAEAJIQDwAAAAAAAAAAEAAQBWACwABAAAAC0BAAAEAAAA8AEDAAcAAAD8AgAAXV1dAAAA BAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAAAQACAFYALQAEAAAALQEAAAQAAADwAQMABwAAAPwCAABg YGAAAAAEAAAALQEDAAwAAABACSEA8AAAAAAAAAABAAEAVgAvAAQAAAAtAQAABAAAAPABAwAHAAAA /AIAAGJiYgAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAEAAQBWADAABAAAAC0BAAAEAAAA8AED AAcAAAD8AgAAZGRkAAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAAAQACAFYAMQAEAAAALQEAAAQA AADwAQMABwAAAPwCAABnZ2cAAAAEAAAALQEDAAwAAABACSEA8AAAAAAAAAABAAEAVgAzAAQAAAAt AQAABAAAAPABAwAHAAAA/AIAAGlpaQAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAEAAgBWADQA BAAAAC0BAAAEAAAA8AEDAAcAAAD8AgAAbGxsAAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAAAQAB AFYANgAEAAAALQEAAAQAAADwAQMABwAAAPwCAABubm4AAAAEAAAALQEDAAwAAABACSEA8AAAAAAA AAABAAIAVgA3AAQAAAAtAQAABAAAAPABAwAHAAAA/AIAAHFxcQAAAAQAAAAtAQMADAAAAEAJIQDw AAAAAAAAAAEAAQBWADkABAAAAC0BAAAEAAAA8AEDAAcAAAD8AgAAc3NzAAAABAAAAC0BAwAMAAAA QAkhAPAAAAAAAAAAAQABAFYAOgAEAAAALQEAAAQAAADwAQMABwAAAPwCAAB1dXUAAAAEAAAALQED AAwAAABACSEA8AAAAAAAAAABAAEAVgA7AAQAAAAtAQAABAAAAPABAwAHAAAA/AIAAHd3dwAAAAQA AAAtAQMADAAAAEAJIQDwAAAAAAAAAAEAAQBWADwABAAAAC0BAAAEAAAA8AEDAAcAAAD8AgAAeXl5 AAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAAAQACAFYAPQAEAAAALQEAAAQAAADwAQMABwAAAPwC AAB8fHwAAAAEAAAALQEDAAwAAABACSEA8AAAAAAAAAABAAEAVgA/AAQAAAAtAQAABAAAAPABAwAH AAAA/AIAAH5+fgAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAEAAgBWAEAABAAAAC0BAAAEAAAA 8AEDAAcAAAD8AgAAgYGBAAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAAAQABAFYAQgAEAAAALQEA AAQAAADwAQMABwAAAPwCAACDg4MAAAAEAAAALQEDAAwAAABACSEA8AAAAAAAAAABAAIAVgBDAAQA AAAtAQAABAAAAPABAwAHAAAA/AIAAIaGhgAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAEAAQBW AEUABAAAAC0BAAAEAAAA8AEDAAcAAAD8AgAAiIiIAAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAA AQABAFYARgAEAAAALQEAAAQAAADwAQMABwAAAPwCAACKiooAAAAEAAAALQEDAAwAAABACSEA8AAA AAAAAAABAAIAVgBHAAQAAAAtAQAABAAAAPABAwAHAAAA/AIAAI2NjQAAAAQAAAAtAQMADAAAAEAJ IQDwAAAAAAAAAAEAAQBWAEkABAAAAC0BAAAEAAAA8AEDAAcAAAD8AgAAkJCQAAAABAAAAC0BAwAM AAAAQAkhAPAAAAAAAAAAAQACAFYASgAEAAAALQEAAAQAAADwAQMABwAAAPwCAACTk5MAAAAEAAAA LQEDAAwAAABACSEA8AAAAAAAAAABAAEAVgBMAAQAAAAtAQAABAAAAPABAwAHAAAA/AIAAJWVlQAA AAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAEAAgBWAE0ABAAAAC0BAAAEAAAA8AEDAAcAAAD8AgAA mJiYAAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAAAQABAFYATwAEAAAALQEAAAQAAADwAQMABwAA APwCAACampoAAAAEAAAALQEDAAwAAABACSEA8AAAAAAAAAABAAIAVgBQAAQAAAAtAQAABAAAAPAB AwAHAAAA/AIAAJ2dnQAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAEAAQBWAFIABAAAAC0BAAAE AAAA8AEDAAcAAAD8AgAAn5+fAAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAAAQACAFYAUwAEAAAA LQEAAAQAAADwAQMABwAAAPwCAACioqIAAAAEAAAALQEDAAwAAABACSEA8AAAAAAAAAABAAEAVgBV AAQAAAAtAQAABAAAAPABAwAHAAAA/AIAAKSkpAAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAEA AgBWAFYABAAAAC0BAAAEAAAA8AEDAAcAAAD8AgAAp6enAAAABAAAAC0BAwAMAAAAQAkhAPAAAAAA AAAAAQACAFYAWAAEAAAALQEAAAQAAADwAQMABwAAAPwCAACqqqoAAAAEAAAALQEDAAwAAABACSEA 8AAAAAAAAAABAAIAVgBaAAQAAAAtAQAABAAAAPABAwAHAAAA/AIAAK2trQAAAAQAAAAtAQMADAAA AEAJIQDwAAAAAAAAAAEAAQBWAFwABAAAAC0BAAAEAAAA8AEDAAcAAAD8AgAAr6+vAAAABAAAAC0B AwAMAAAAQAkhAPAAAAAAAAAAAQACAFYAXQAEAAAALQEAAAQAAADwAQMABwAAAPwCAACysrIAAAAE AAAALQEDAAwAAABACSEA8AAAAAAAAAABAAIAVgBfAAQAAAAtAQAABAAAAPABAwAHAAAA/AIAALW1 tQAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAEAAgBWAGEABAAAAC0BAAAEAAAA8AEDAAcAAAD8 AgAAuLi4AAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAAAQACAFYAYwAEAAAALQEAAAQAAADwAQMA BwAAAPwCAAC7u7sAAAAEAAAALQEDAAwAAABACSEA8AAAAAAAAAABAAIAVgBlAAQAAAAtAQAABAAA APABAwAHAAAA/AIAAL6+vgAAAAQAAAAtAQMADAAAAEAJIQDwAAAAAAAAAAEAAgBWAGcABAAAAC0B AAAEAAAA8AEDAAcAAAD8AgAAwMDAAAAABAAAAC0BAwAMAAAAQAkhAPAAAAAAAAAAAQABAFYAaQAH AAAA/AIAAMLCwgAAAAQAAAAtAQQADAAAAEAJIQDwAAAAAAAAAAEAAgBWAGoABAAAAC0BAAAEAAAA 8AEEAAcAAAD8AgAAxMTEAAAABAAAAC0BBAAMAAAAQAkhAPAAAAAAAAAAAQABAFYAbAAEAAAALQEA AAQAAADwAQQABwAAAPwCAADGxsYAAAAEAAAALQEEAAwAAABACSEA8AAAAAAAAAABAAIAVgBtAAQA AAAtAQAABAAAAPABBAAHAAAA/AIAAMjIyAAAAAQAAAAtAQQADAAAAEAJIQDwAAAAAAAAAAEAAQBW AG8ABAAAAC0BAAAEAAAA8AEEAAcAAAD8AgAAysrKAAAABAAAAC0BBAAMAAAAQAkhAPAAAAAAAAAA AQACAFYAcAAEAAAALQEAAAQAAADwAQQABwAAAPwCAADNzc0AAAAEAAAALQEEAAwAAABACSEA8AAA AAAAAAABAAIAVgByAAQAAAAtAQAABAAAAPABBAAHAAAA/AIAAM/PzwAAAAQAAAAtAQQADAAAAEAJ IQDwAAAAAAAAAAEAAQBWAHQABAAAAC0BAAAEAAAA8AEEAAcAAAD8AgAA0dHRAAAABAAAAC0BBAAM AAAAQAkhAPAAAAAAAAAAAQACAFYAdQAEAAAALQEAAAQAAADwAQQABwAAAPwCAADT09MAAAAEAAAA LQEEAAwAAABACSEA8AAAAAAAAAABAAIAVgB3AAQAAAAtAQAABAAAAPABBAAHAAAA/AIAANXV1QAA AAQAAAAtAQQADAAAAEAJIQDwAAAAAAAAAAEAAgBWAHkABAAAAC0BAAAEAAAA8AEEAAcAAAD8AgAA 19fXAAAABAAAAC0BBAAMAAAAQAkhAPAAAAAAAAAAAQACAFYAewAEAAAALQEAAAQAAADwAQQABwAA APwCAADZ2dkAAAAEAAAALQEEAAwAAABACSEA8AAAAAAAAAABAAIAVgB9AAQAAAAtAQAABAAAAPAB BAAHAAAA/AIAANvb2wAAAAQAAAAtAQQADAAAAEAJIQDwAAAAAAAAAAEAAgBWAH8ABAAAAC0BAAAE AAAA8AEEAAcAAAD8AgAA3d3dAAAABAAAAC0BBAAMAAAAQAkhAPAAAAAAAAAAAQACAFYAgQAEAAAA LQEAAAQAAADwAQQABwAAAPwCAADf398AAAAEAAAALQEEAAwAAABACSEA8AAAAAAAAAABAAIAVgCD AAQAAAAtAQAABAAAAPABBAAHAAAA/AIAAOHh4QAAAAQAAAAtAQQADAAAAEAJIQDwAAAAAAAAAAEA AgBWAIUABAAAAC0BAAAEAAAA8AEEAAcAAAD8AgAA4+PjAAAABAAAAC0BBAAMAAAAQAkhAPAAAAAA AAAAAQACAFYAhwAEAAAALQEAAAQAAADwAQQABwAAAPwCAADl5eUAAAAEAAAALQEEAAwAAABACSEA 8AAAAAAAAAABAAIAVgCJAAQAAAAtAQAABAAAAPABBAAHAAAA/AIAAOfn5wAAAAQAAAAtAQQADAAA AEAJIQDwAAAAAAAAAAEAAwBWAIsABAAAAC0BAAAEAAAA8AEEAAcAAAD8AgAA6enpAAAABAAAAC0B BAAMAAAAQAkhAPAAAAAAAAAAAQACAFYAjgAEAAAALQEAAAQAAADwAQQABwAAAPwCAADr6+sAAAAE AAAALQEEAAwAAABACSEA8AAAAAAAAAABAAMAVgCQAAQAAAAtAQAABAAAAPABBAAHAAAA/AIAAO3t 7QAAAAQAAAAtAQQADAAAAEAJIQDwAAAAAAAAAAEAAwBWAJMABAAAAC0BAAAEAAAA8AEEAAcAAAD8 AgAA7+/vAAAABAAAAC0BBAAMAAAAQAkhAPAAAAAAAAAAAQADAFYAlgAEAAAALQEAAAQAAADwAQQA BwAAAPwCAADx8fEAAAAEAAAALQEEAAwAAABACSEA8AAAAAAAAAABAAMAVgCZAAQAAAAtAQAABAAA APABBAAHAAAA/AIAAPPz8wAAAAQAAAAtAQQADAAAAEAJIQDwAAAAAAAAAAEABABWAJwABAAAAC0B AAAEAAAA8AEEAAcAAAD8AgAA9fX1AAAABAAAAC0BBAAMAAAAQAkhAPAAAAAAAAAAAQAFAFYAoAAE AAAALQEAAAQAAADwAQQABwAAAPwCAAD39/cAAAAEAAAALQEEAAwAAABACSEA8AAAAAAAAAABAAQA VgClAAQAAAAtAQAABAAAAPABBAAHAAAA/AIAAPn5+QAAAAQAAAAtAQQADAAAAEAJIQDwAAAAAAAA AAEABQBWAKkABAAAAC0BAAAEAAAA8AEEAAcAAAD8AgAA+/v7AAAABAAAAC0BBAAMAAAAQAkhAPAA AAAAAAAAAQAJAFYArgAEAAAALQEAAAQAAADwAQQABwAAAPwCAAD9/f0AAAAEAAAALQEEAAwAAABA CSEA8AAAAAAAAAABAAkAVgC3AAQAAAAtAQAABAAAAPABBAAEAAAALQEAAAwAAABACSEA8AAAAAAA AAABAAQAVgDAAAQAAAAtAQEABAAAAC0BAAAEAAAAJwH//wQAAAAuARgABAAAAAIBAQAFAAAACQIz M5kCHAAAAPsC9/8AAAAAAACQAQAAAAAAQAAiVGFob21hAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAEAAAALQEEACcAAAAyCk8AGAAVAAAATkVVTU9OSUEgSE9TUElUQUxBUklBAAYABAAFAAYABgAF AAIABgACAAUABgAEAAUAAgAEAAYAAgAGAAUAAgAGAAQAAAAuAQAAHAAAAPsCAAAAAAAAAAAAAAAA AAAAAAABQ291cmllciBOZXcAKADHAQAAeij2vwAAUBJY5WIALCMEAAAALQEFAAQAAADwAQQABAAA AC0BBQAEAAAALgEYAAUAAAAJAgAAAAIcAAAA+wL4/wAAAAAAAJABAAAAAABAACJUYWhvbWEAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAQAAAAtAQQAMAAAADIKbwA+ABsAAABQcm9mLiBEcmEuIEFk ZWxpbmEgQnJhc2VsbGmgBAADAAMAAwABAAIABQACAAQAAQACAAUABAADAAIAAQAEAAMAAgAEAAMA AwADAAQAAQACAAIABAAAAC4BAAAEAAAALQEFAAQAAADwAQQABAAAAC4BGAAcAAAA+wL6/wAAAAAA AJABAAAAAABAACJUYWhvbWEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAQAAAAtAQQAEgAAADIK eABSAAcAAABBR09TVE8gAAMABAAEAAIAAwAEAAEABAAAAC4BAAAEAAAALQEFAAQAAADwAQQABAAA AC4BGAAcAAAA+wL6/wAAAAAAAJABAAAAAABAACJUYWhvbWEAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAQAAAAtAQQACQAAADIKeABnAAEAAAAtIgIABAAAAC4BAAAEAAAALQEFAAQAAADwAQQABAAA AC4BGAAcAAAA+wL6/wAAAAAAAJABAAAAAABAACJUYWhvbWEAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAQAAAAtAQQADQAAADIKeABrAAQAAAAyMDAyAwACAAMAAwAEAAAALgEAAAQAAAAtAQUABAAA APABBAADAAAAAAA= ------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/master19.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"
Haga clic para cambiar el estilo = de título
Haga clic para modificar el estil= o de subtítulo del patrón
‹= fecha y hora›
‹pie de página›
‹Nº›
------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/master19.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/slide0001.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" NEUMONIA HOSPITALARIA
NEUMONIA HOSPITALARIA
Prof. Dra. Adelina Braselli
AGOSTO - 2002
------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/master19_image001.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhEAI/AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAO Aj4AhwAAAAAAAAAAMwAAZgAAmQAAzAAA/wAzAAAzMwAzZgAzmQAzzAAz/wBmAABmMwBmZgBmmQBm zABm/wCZAACZMwCZZgCZmQCZzACZ/wDMAADMMwDMZgDMmQDMzADM/wD/AAD/MwD/ZgD/mQD/zAD/ /zMAADMAMzMAZjMAmTMAzDMA/zMzADMzMzMzZjMzmTMzzDMz/zNmADNmMzNmZjNmmTNmzDNm/zOZ ADOZMzOZZjOZmTOZzDOZ/zPMADPMMzPMZjPMmTPMzDPM/zP/ADP/MzP/ZjP/mTP/zDP//2YAAGYA M2YAZmYAmWYAzGYA/2YzAGYzM2YzZmYzmWYzzGYz/2ZmAGZmM2ZmZmZmmWZmzGZm/2aZAGaZM2aZ ZmaZmWaZzGaZ/2bMAGbMM2bMZmbMmWbMzGbM/2b/AGb/M2b/Zmb/mWb/zGb//5kAAJkAM5kAZpkA mZkAzJkA/5kzAJkzM5kzZpkzmZkzzJkz/5lmAJlmM5lmZplmmZlmzJlm/5mZAJmZM5mZZpmZmZmZ zJmZ/5nMAJnMM5nMZpnMmZnMzJnM/5n/AJn/M5n/Zpn/mZn/zJn//8wAAMwAM8wAZswAmcwAzMwA /8wzAMwzM8wzZswzmcwzzMwz/8xmAMxmM8xmZsxmmcxmzMxm/8yZAMyZM8yZZsyZmcyZzMyZ/8zM AMzMM8zMZszMmczMzMzM/8z/AMz/M8z/Zsz/mcz/zMz///8AAP8AM/8AZv8Amf8AzP8A//8zAP8z M/8zZv8zmf8zzP8z//9mAP9mM/9mZv9mmf9mzP9m//+ZAP+ZM/+ZZv+Zmf+ZzP+Z///MAP/MM//M Zv/Mmf/MzP/M////AP//M///Zv//mf//zP///wECAwECAwECAwECAwECAwECAwECAwECAwECAwEC AwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwEC AwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwj/AAEIHEiwoMGDCAGwYJGwocOHECNKnEix osWLGDNq3Mixo8ePIEOKHDkyAEOSKFOqXMmypcuXMGPKnDmRRQCaOHPq3Mmzp8+fQC2aDEq0qNGj SJMqzWlzqdOnUKNKnQp0KNWrWLNq3Zr0hdevYMOGtek1i9ksg9IOcsXWFba3b7nKnUu3rl2EYvPm NflVC9oshNYOwtaKsGFsdxMrXsz4qN7HXxd+PZvW1Vq3buEibsy5s+fPKAnkFS2W9Au+WV6YJQRY sKvChd+2Ak27tu3bDSFDJquastrXbDVvxk28uHHFuh+jfuF3UGvLhgtnPk69unWqyfXy7o12UODg meFe/x9PvjxQsKbR72Whujfr72thw51tvr79+yyz5+V9tnvltsLhJ+CABGqkn1h8edXcc4PJF1uB EEYo4UEHjsVeWWZVdhk24cU14YcgCpjeVyN6ZdpyqzH42mGEhejii+NVCBZ/vlXWSnCawajjjrjJ +NVyC8IXHYce8mjkkYz56NV2vn2HWYBIRinlXOqVtl57KcK3YmwtTunll1Mp+QKNGf4GYI5gpqkm UmImyNxfQjpY5Jp01rmTmJJh2J1l4EFp55+AwlTiC4OeyF5qWbomn2yBNupoSngGoKd/8eEo3qOY ZopQNMpw6qkyygwT6qjDlDoML6emiiovvNTSai1gAf8Jp2BDTqfprbdGoyunoPYKqqjAmiosq8QS C2tkkuqZlpNEoonrs45+Go0pn/b6CamhDoOJqqliQmysh7qn4qJdQmvun7vu6uu6pApr6qrFzphs f2pdZumc5+abprrSduorsNiWuqqqvDQzTTPNmISwwQtT04wzzlTzjDXPXAONxdhEg801GV+q78c7 ppsuu+y6+66qCzezUMopQ/zMy89Ac/HF19Qs3HAg5xwiYfx2Sq2/1gaszCcno5rKwgo3c/TCEFej yssUW3MxK9dorLFsOOusdYQiiww0ydmavGrKNrHMtDMwxwyNNdHUbLOfW8dNYMdd+1vtr0IPO0wz Dif/zELDDaMd8cQVX2w13R7Lrfh9u2bcdb8kmyww2QGYjbDLMMtssc0cw7345+QhXljXP1d7LcCi El1qykmnnIrLg1uzitSba1wYxxqDrjt5h1v9uK5frxusqZRb/jDaMEtNu9s37+58dYj7Ln2/1aKe LcN+L3wwwg43Tfjm0HSMe+LPl2/b1dH/rm7kpJL9t+WYv6w5zW87a/79oBnWu/6O61q63aboFcCW lj2ltSxiTyMc7ah2OKzh74GfuVnv1Ac8sIWqePBDnvzW1jbmeQ6CILxL9EY4PbuZUIDK4BvCWtc3 vglOYhSr3QjxFcIazkUz6JsgBXvFq15h0GzxU9vm/zjWOfvZ8Ihb6RjW9je6/k2LegEEFeve5zrY wXB2M6uaYcaHxC4m8WZw0aH6TpjChZUtg2lTHv2KSD4vuhEqYSQhCXXlOBPyCnut254KvRfDmYlP iVl7oyCVAkbh5DAaJjHJQhRpk4U00pGQjKQkJ0nJSjryCpfM5EIwyclMXuGTLPgkJ0EpylKa8pSo TKUqUykIUbbyk6+8QixbKYhaytKWtaRlLnfJy1768pfA9GUrcjnMWhZTEMccZiuWiUxmLlOZzozm M6dJzWpa85rYzOY1CbNMbsKmm8/05pDCKSesmZNFXErnfNZ5My4V8p3wjKc850nPetaTS+hr4uFa 0f/IRPbzn/5kpEAdyUhLRrKTCA2lQhPK0IU6tKEQDSUpJzrKiqKSlrLMKEY3qtGOcvSjHvUoLkeq y5IKk5jITKkyVcrSlbq0pTB9qUxbKs1mQvOmNtWmOOXE03H6tKdA/alQg0rUoRqVXOVEJzuVek51 NnWpTmWqcNy5VM1Q1Z7YCChBDcrVrnqVkpjcpCcf+lCKrvKsaE2rKmcZ0pLeMphwjatc55rMmNL0 ptrMq173ytds7hScRw1sT5+K1cIa9rCITew7N8I9y/WNhYF7RuwKp8X90XCQmLWL8Vh2RiBqUIg0 21jzMkvau7CMgFM02+teODEsyvB2HSutbOmy2R9lsiyIanQbGy87295KBWF6DO4KqajH7k0WfH9E n2+Xe5XampGKt/3s/HQ7WuZa9ykGVC3S3ofapiUwalOr7DqvS96lOBdhnY1u2mTGNup+sLzwhYpV 4kvf2jSlvvj9zHzzy1+dBAQAOw== ------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/slide0002.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" NEUMONIA HOSPITALARIA
DEFINICIÓN Y EPIDEMIOLOGÍA
nDEFINICI&Oacu= te;N:
nFIEBRE Y NUEVO INFILTRADO PULMONAR, DESPUÉS DE 72 HORAS DE LA HOSPITALIZACIÓN Y QUE NO LA ESTABA INCUB= ANDO ANTES
n<= span lang=3DES-TRAD style=3D'font-size:56%;display:none'>
nEPIDEMIOLOG&I= acute;A
nINFECCIÓN HOSPITALARIA FRECUENTE
n<= span lang=3DES-TRAD style=3D'font-size:56%;display:none'>
nPACIENTES CON INTUBACIÓN TRA= QUEAL O VM TIENEN UN RIESGO DE NEUMONÍA NOSOCOMIAL 6 A 20 VECES MAYOR <= /div>
n
n1er=  CAUSA DE MUERTE POR INFECCIÓ= ;N NOSOCOMIAL
n
nMAYOR MORBIMORTALIDAD EN PACIENTES INTERNADOS EN UCI, ESPECIALMENTE LOS SOMETIDOS A VENTILACIÓN MECÁNICA =
n<= span lang=3DES-TRAD style=3D'font-size:56%;display:none'>
nSOBRECARGA EN DÍAS DE HOSPITALIZACIÓN Y COSTOS ECONÓMICOS
------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/master18_image002.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhNAA2AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAz ADQAhQAAADMzzDY2zD4+zUlJzlZW0GJi0nBw1H5+14yM2pub3qmp4ra25cLC6c7O7djY8P/PAf/Q G//RNP/TRv/UV//Xaf/Ze//djP/hnf/mrv/qvf/ty//x1v/14f/36f/68P/79v/9+v/+/P///uHh 9Ojo9u/v+PT0+/j4/Pv7/f39/v///wECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwEC AwECAwECAwECAwECAwECAwECAwECAwECAwb/QIhwSCwahRHJhFKxXDAZzYbT8XxAIdEIwO12j2Bw ctl8RqfVa3br9YbfxDHTCZVSrVht2w2Hy8t1aHhre199b390Z3dqeoUAh4hKc2Z2aXlshZFhiZWC jZl7m2KTgIuXhI+jR52BjJiPkKtFraeDjpqzcaWKlrehbbq7ZL2fsKrCSLyer6m5ybW+oLHJysTM qLii1dHGztvQy67ZwHzh1+O/1NzittPI55Tp78/C3c3awezo7sf1uvfIrYtnSpo/cPbaGfymz0iA hxAjSpwoYACBAgYOIEigYAGDBg4ekChh4gSKFCpWgJnIsmXFixk3dvwYcmTJkylXttwJ8SVGwY0c PYIUSdIkyhWPeCr1GTMoTaI3jyZVupMp0JlDbRpNOZUqS6syhdYsihNpIa8uLf4M+1Rr2a5oI4J1 mpWs1LNxJc7FOjYqV7x5e6ptyhfqVrN7AssdfFWs4beAFe917PZuYsUPJ7e1+/cyZs11/SJugzkz Y7ahD8MNDLqv6sisT9N1DdmzZNmFK3cmXbr1Y8u8P+OmzHm0l9IBfOs23gW58uKr8z4XHT3u9Ne2 Y8NsvJk6bOnDu2MPfns7atpHgwAAOw== ------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/master18_image003.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhIgAaAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAh ABkAhwAAAP8cHP8SEv8HB/8fH/8VFf89Pf84OP8yMv8tLf8mJv8+Pv85Of80NP8vL/8qKv87O/82 Nv8xMf8rK/8jI/83N/9bW/9WVv9RUf9MTP9HR/9CQv9dXf9YWP9TU/9OTv9JSf9ERP9fX/9aWv9V Vf9PT/9KSv9FRf9AQP9DQ/9UVP9ISP97e/92dv9wcP9ra/9mZv9hYf99ff93d/9ycv9tbf9nZ/9i Yv9/f/95ef90dP9vb/9paf9kZP9ubv9gYP9+fv91df9lZf+env+Zmf+UlP+Pj/+Kiv+Fhf+AgP+b m/+Wlv+Rkf+MjP+Hh/+Cgv+cnP+Xl/+Skv+Njf+IiP+EhP+Dg/+Vlf+QkP+amv+Li/+Tk/+fn/+6 uv+2tv+xsf+trf+oqP+jo/+7u/+3t/+zs/+urv+qqv+lpf+goP+9vf+4uP+0tP+wsP+rq/+np/+i ov++vv+/v/+hof+1tf+ysv+vr/+mpv+8vP+srP+pqf/AwP/Fxf/Bwf/Ly//Gxv/Cwv/Pz//MzP/I yP/ExP/U1P/Q0P/Nzf/Jyf/Y2P/V1f/R0f/Ozv/Kyv/c3P/Z2f/W1v/T0//d3f/a2v/X1//e3v/b 2//f3//S0v/Dw//Hx//g4P/k5P/h4f/n5//l5f/i4v/q6v/o6P/m5v/j4//t7f/r6//p6f/w8P/u 7v/s7P/y8v/09P/x8f/v7//29v/19f/z8//4+P/5+f/39//7+//6+v/8/P/9/f/+/v///wECAwEC AwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwEC AwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwEC AwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwEC AwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwj/ALt4+QImjJghRIoYOYIkCYsWLl7AiGHh AoYMGjYYOIAggYIAAgbsGUOmjJkzaNIoWcKkiZMnMmbQqGHjBocOHj6ACLGAQQMHDwgU4NNHzRo2 bdy8gQMlipQpVKrgyKFjB48eIkaQKGHiBAoIESRMoODnD6A4AgkaRKiQoUOIEilaxKixQsdAggYR kkPSJEqVLF3ClEnTJk6dKXo2KGToECKiRpEqZeoUqpWpOnxczaqCq1cIiRQtYtTILNqBBQ8mXNjw YUQYPypezOjoEaRIePXyLXkypZIrWATHnFnzZs4VmyRNosTYMeSjSd/MafqUihUgVDVjHdGZU6dK lkKP/y59tgsdtarbtg4SUUjsC54+gbpUGxKm3Jl21+mtErhwwsWFIsoopCS3XHOPFQWdUtNVZh12 mV1ViimnjOIdeOKRZpp56LHFmkPsvYBKKqqcEt989d2XV34k7fdXFsBp8dJwq4yoioAEGshcYwlG ZocbdzRY3XU5sLJKK65MWOGF4YmmYXnnpeahW6/AEksrNpooH322qTgIi2S4mBKMWMgoS5VG2ohj gcrt6FwfeBz1Y5DUTTGLLLS8YiSSSlr4XZPjbXheHmsRsUUttuBZ5ZVZnsilfXhpAuZ+eqDBRRa1 IHrnojWSuKaOkfBIVJxszDnHLbdoquieSVLoJ4ZOkjqH1qBh4IJLqogqaiWSJGqJYpeB+CGpfmbk YiuutmxqZac3DsjmcqG+SaouuRiLqqp5stonkxnK2kVAADt= ------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/master18_image004.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhBAA/AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AD0AgAAAABwcHAIGjI+py+1aADt= ------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/master18_image005.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh4gEEAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAADg AQIAhwAAAB0dHR4eHh8fHyAgICEhISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0t LS4uLi8vLzAwMDExMTIyMjMzMzQ0NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BA QEFBQUJCQkREREVFRUZGRkdHR0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RU VFVVVVZWVldXV1hYWFlZWVpaWltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdn Z2hoaGlpaWpqamtra2xsbG1tbW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6 ent7e3x8fH19fX5+fn9/f4CAgIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2N jY6Ojo+Pj5CQkJGRkZKSkpOTk5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6Cg oKGhoaKioqOjo6SkpKWlpaampqenp6ioqKqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0 tLW1tba2tre3t7i4uLm5ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfH x8jIyMnJycrKysvLy8zMzM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra 2tvb29zc3N3d3d7e3t/f3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t 7e7u7u/v7/Dw8PHx8fLy8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///wEC AwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwEC AwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwj/AAMIEDBgAIECBg4cQIAggYIFCxgwaODg AQQIESJIkDBhAoUKFkJewJAhgwYNGzhw6ODBw4cPIEKIGDGCBIkSJUyYOHECBYoUKVSsWMGCRQsX L17AgBFDxowZNGrUsGHjxg0cOXTo2LGDRw8fPn4AARIkiJAhRIgUKWLkCBIkSZQsYcKkSRMnT6BA iRJFipQpVKpYsXLlCpYsWrRs2cKli5cvX8CACSNmzBgyZcyYOXMGTZo0atawYdPGzZs3cODEkTOH Dp06dezYuYMnTx49evbw6ePHz58/gAAFEjRoECFChQwdQoQoUSJFihYtYsSoUSNHjh5BghQpkqRJ lChV/6pkydKlS5gwZdK0iROnTp08efr0CRSoUKFEjRpFilSpUqaYcsopqKCSSiqqrLIKK6y00oor rrzyCiywxBKLLLPMQgsttXRYiy223HILLrjkosuJuuyyCy+89NKLLzD68gswwARjYzDCCDPMjsMQ Q0wxxgRpzDFEHoMMMskkmYwyyzS5DDNQMtPMlM04Y+UzWD4DzZbQRONlNNKEKc00ZFJjJjXVpKmm NWyyec2bcGIj55zZ1FmnNnjmuc2efG7DzZ+A/tnNoIQS6s2hiCb6zaKMNvoNOJBGKumk4VRqaaUC EWQQQgox5BBEElFkEUYaceQRSCKRZBJKKrHkEkwy0ehkE0468eQTUEIRZRRSSjHlFFRSUWUVVlpx 5RVYYpFlFlpqseUWXHLRZRdeevHlF2CCEWYYYoox5hhkklFmGWaaceYZaKKRZhpqqrHmGmyy0WYb brrx5htwwhFnHHLKMeccdNJRZx122nHnHXjikWceeuqx5x588tFnH3768ecfgAISaCCCCjLoIIQS Umghhhpy6CGIIpJoIooqsuhijDLSeCOOOvLoI5BCFmkkkkoy6WSUUlJppTNZasnll2CKSeY0Z6Kp Zpptugnnm3PSaWc2eerZ556BBlro14mG7Y2jZE9qtqSXXhoQADs= ------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/slide0018.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" NEUMONIA HOSPITALARIA
PATOGENIA
nDEBE OCURRIR UNA DE ESTAS CONDICIONES: =
n
nCOM= PROMISO DE LAS DEFENSAS DEL HUÉSPED
n
nIN&= Oacute;CULO SUFICIENTEMENTE GRANDE, QUE SOBREPASE LAS DEFENSAS DEL HUÉSPED
n
nMIC= ROORGANISMO DE SUFICIENTE VIRULENCIA
------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/slide0003.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" NEUMONIA HOSPITALARIA
PATOGENIA
Ø= MICROASPIRACIÓN DE SECREC= IONES OROFARÍNGEAS:
n<= span lang=3DES-TRAD style=3D'font-size:50%;display:none'>
nLa colonización de la orofaringe con gérmenes nosocomiales es la principal fuente de origen de la infección.
nLa frecuencia de colonización aumenta con la severidad de la enfermedad de base.
nLa colonización es precoz, d= entro de los 4 primeros días.
nLa colonización gástr= ica precediendo a la coloización de la vía aérea fue demostrada en una minoría de pacientes
n
nEl 2º paso es la microaspiración con llegada del patógeno al= tracto respiratorio bajo.
nEl riesgo de microaspiración= aumenta con el decúbito dorsal, si hay alteración de <= span style=3D'position:absolute;top:72.5%;left:17.79%;width:87.82%;height:3.75%= '>conciencia, trastornos deglutorios,= sonda nasogástrica, tubo endotraqueal, reflujo gastroesofágico. =
n<= span lang=3DES-TRAD style=3D'font-size:50%;display:none'>
nOTROS MECANISMOS= MENOS FRECUENTES:
Ø= DISEMINACIÓN HEMATÓGE= NA DESDE FOCO DISTANTE
Ø= PENETRACIÓN EXÓGENA (= ej.: toracostomía)
n
------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/slide0004.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" NEUMONIA HOSPITALARIA
FACTORES DE RIESGO PARA NIH (1)
nRELACIONADOS CON EL PACIENTE= :
= n
ü= edad;
ü= malnutrición/obesidad; =
ü= hábito de fumar; abuso de al= cohol; UDIV;
ü= EPOC; 
ü= otra comorbilidad (aguda o cr&oacut= e;nica);
ü= inmunosupresión; =
ü= alteración de conciencia; &#= 13;
ü= disfunción diafragmát= ica y bloqueo neuromuscular;
ü= hospitalización prolongada.<= /span>
------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/slide0013.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" NEUMONIA HOSPITALARIA
FACTORES DE RIESGO PARA NIH (2)
§
nRELACIONADOS CON EL CONTROL DE <= /b>INFECCIONES:
ü
ü= lavado de manos;
ü= uso de guantes; =
ü= desinfección de equipos; = ;
ü= condiciones del ambiente;
ü= infección cruzada paciente/paciente.
n
------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/slide0014.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" NEUMONIA HOSPITALARIA
FACTORES DE RIESGO PARA NIH (3)
nRELACIONADOS CON LA INTERVENCI&O= acute;N:
ü
ü= prolongada o repetida administraci&= oacute;n de antibiótico;
ü= uso de  sedantes, analgésicos narcóticos e = inmunosupresores;
ü= alcalinización del medio gástrico;
ü= alimentación enteral;
ü= intubación endotraqueal; FBC= ; LBA; broncoaspiración;
ü= sinusitis maxilar (aumenta con intubación nasogástrica o nasotraqueal);
ü= cirugía: cabeza, cuello, tórax y abdomen.&= #13;
= n
n<= span style=3D'font-size:88%;mso-special-format:lastCR;display:none'>
------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/slide0005.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" NEUMONIA HOSPITALARIA
ETIOLOGÍA
nBACTERIAS: 80= A 90%, VIRUS 10 A 20%, HONGOS < 1%.
n=
nGÉRMEN= ES MÁS FRECUENTES:
nEnterobacilos (E. coli, especies de Klebsiella, Proteus, Enterobacter, Serratia)
n
nOtros bacilos gram negativos: espec= ies de Pseudomonas y Acinetobacter  = 3;
n<= span lang=3DES-TRAD style=3D'font-size:63%;display:none'>
nS. aureus
n=
nMEN= OS FRECUENTES : Streptococcus pneumoniae, Hemophilus influenzae y Moraxella catarrhalis en EPOC, anaerobios en neumonías aspirativas, hongo= s en inmunodeprimidos.
n= 3;
n= 3;
n<= span style=3D'font-size:88%;mso-special-format:lastCR;display:none'>
------=_NextPart_01C28063.34D09E00 Content-Location: file:///C:/86E1D161/NEUMONIAHOSPITALARIA_archivos/slide0017.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" NEUMONIA HOSPITALARIA