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Early onset pneumonia: a multicenter study in intensive care units
M Langer1, M Cigada, M Mandelli
1Istituto di Anestesiologia e Rianimazione, Ospedale Maggiore, Italy.
Intensive Care Medicine
|January 1, 1987
Summary
Pneumonia acquired in intensive care units (ICUs) affects 21.3% of patients, with early onset common. Impaired airway reflexes and prolonged respiratory support are key risk factors for developing this serious infection.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Hospital-acquired pneumonia (HAP) is a significant concern in intensive care units (ICUs).
- Understanding the incidence, timing, and risk factors for pneumonia in ICUs is crucial for effective prevention and treatment strategies.
Purpose of the Study:
- To determine the incidence, onset time, and risk factors for pneumonia in patients admitted to intensive care units.
- To investigate the mortality associated with pneumonia in this patient population.
Main Methods:
- A prospective, multicenter study involving 16 intensive care units in Lombardy, Northern Italy.
- Inclusion criteria: ICU stay > 48 hours, no prior pulmonary infection or terminal illness.
- Data collected on 441 eligible patients over a 3-month period.
Main Results:
- The incidence of acquired pneumonia was 21.3% (94/441 patients).
- Early onset pneumonia (within 4 days of admission) accounted for 54.2% of cases.
- Significant risk factors for early onset pneumonia included impaired airway reflexes (RR=12.4) and >24 hours of respiratory assistance (RR=3.3).
- Prophylactic antibiotic therapy offered no protection.
Conclusions:
- Aspiration due to depressed protective reflexes is a likely cause of early onset ICU-acquired pneumonia.
- Impaired airway reflexes and prolonged mechanical ventilation are critical risk factors.
- Current prophylactic antibiotic strategies appear ineffective in preventing ICU-acquired pneumonia.