Chest
Clinical InvestigationsNosocomial Respiratory Tract Infections in Multiple Trauma Patients: Influence of Level of Consciousness with Implications for Therapy
Section snippets
Population Study
The study was conducted from January 1988 until July 1990, in a 16-bed medical-surgical ICU, at a 1,000-bed teaching hospital which serves as both a referral center and a first-line hospital. All multiple trauma patients admitted to the ICU were included. Age, sex, date of admission, underlying diseases, and diagnosis on admission were recorded. Prior antibiotic therapy, surgery, smoking, and alcohol habits, as well as the presence of chronic obstructive pulmonary disease (COPD), mechanical
RESULTS
One hundred sixty-one multiple trauma patients were admitted to our intensive care unit during the study period. Some relevant characteristics of these patients are summarized in Table 1. One hundred eight (67 percent) patients received mechanical ventilation for more than 48 h, through orotracheal (84) or tracheostomy (24) tubes. Only five patients were previously diagnosed with COPD. Eighty-six (53.4 percent) were associated with cranioencephalic trauma, 37 of whom underwent neurosurgical
DISCUSSION
In the review by Baker et al21 of deaths from trauma in San Francisco, 53 percent of the patients were dead at the scene of the injury before transport was available, 7.5 percent of patients died in the emergency room, and 39.5 percent died in the hospital. Sepsis was the cause of death in the majority of late deaths (>7 days). The appearance of sepsis, respiratory insufficiency, and multiple system organ failure are common terminal complications in the course of the multiple trauma victim. The
ACKNOWLEDGMENT
The writers thank Rosa de Vilar for her secretarial assistance.
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Aerosolized antibiotics in the intensive care unit
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Manuscript received August 22; revision accepted November 22.