Management

Aggressive pulmonary care in the ICU cannot be over emphasized. Frequent suctioning and therapeutic bronchoscopy are of significant clinical utility. Suspected nosocomial pneumonia should be treated with empiric antibiotics after attempts are made at identification of the causative organism. The choice of antibiotics should be guided by the flora typically isolated in the ICU. Coverage for gram negatives including Pseudomonas is usually selected. Antibiotics such as broad spectrum penicillins (piperacillin, ticarcillin) are instituted with conversion to a narrow spectrum antibiotic once sensitivities are available.

Several studies have found monotherapy comparable to combination therapy. Newer broad spectrum single agents provide equivalent coverage while sensitivities are ending. Studies have also suggested that in the trauma patient multidrug therapy is associated with increased drug resistance.

References

1. Naziri W, Cheadle WG, Pietsch JD et al. Pneumonia in the surgical intensive care unit. Immunologic keys to the silent epidemic. Ann Surg 1994; 219(6):632-640.

2. Polk HC, Livingston DH, Fry DE et al. Treatment of pneumonia in mechanically ventilated trauma patients. Results of a prospective trial. Arch Surg 1997; 132(10):1082-1092.

3. Civetta JM, Taylor RW, Kirby RR. Critical Care. 3rd ed. PA, Philadelphia: Lippencott-Raven Publishers, 1997.

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