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October 1997

Treatment of Pneumonia in Mechanically Ventilated Trauma Patients: Results of a Prospective Trial

Author Affiliations

From the Departments of Surgery, Price Institute of Surgical Research, and University of Louisville Hospital, University of Louisville School of Medicine, Louisville, Ky (Drs Polk and Cheadle and Mss Trachtenberg and Gardner); University of Medicine and Dentistry of New Jersey, Newark (Dr Livingston); University of New Mexico, Albuquerque (Dr Fry); Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio (Dr Malangoni); University of Tennessee, Memphis (Dr Fabian); and Memorial Medical Center, Modesto, Calif (Dr Kesterson).

Arch Surg. 1997;132(10):1086-1092. doi:10.1001/archsurg.1997.01430340040005

Objectives:  To determine the efficacy and magnitude of associated adverse effects of 2 different antibiotic regimens for the treatment of pneumonia in intubated surgical patients and to assay and compare blood samples and bronchoalveolar lavage fluid with respect to some host-defense parameters, especially in patients with unilateral pneumonia.

Design:  Randomized, prospective, unblinded clinical comparison of 2 treatment arms with respect to intent to treat and clinical and microbiologically evaluable patients.

Setting:  Six university surgical services in teaching hospitals with modern and well-staffed intensive care units.

Interventions:  The consistency and objectivity of the diagnosis of pneumonia was improved by the use of a grid of diagnostic parameters. Aggressive mechanical approaches to pneumonia in intubated surgical patients were supplemented by therapeutic use of aztreonam and vancomycin hydrochloride or combined imipenem and cilastatin sodium.

Results:  Patients randomized to the aztreonamvancomycin group were somewhat more ill, fared slightly better, and had fewer serious drug-related side effects than did those treated with imipenem-cilastatin (all P>.05). Immunologic parameters assessed by evaluation of bronchoalveolar lavage fluid showed differences between infected pulmonary lobes and noninfected ones; some changes were also noted in patients who recovered compared with those whose pneumonia persisted or recurred.

Conclusions:  Clinical studies of pneumonia in surgical patients need to be stratified to assure comparability, to identify patients in whom treatment is likely to fail, and to display differences between more and less effective therapies. Studies of blood and bronchoalveolar lavage samples showed that certain local and systemic immunologic parameters correlate with clinical status and outcome.Arch Surg. 1997;132:1086-1092

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