Preventing posttraumatic pneumonia

Between 20% and 40% of patients admitted to the hospital with multiple trauma develop bacterial pneumonias. The most immediate causes are aspiration, blunt chest trauma, and prolonged immobilization. Traumatic shock and the need for immediate head and chest surgery are contributing factors. Signs of systemic infection, infiltrates on the chest film, and microbiological evidence obtained from sputum samples are the principal diagnostic criteria. Prophylactic measures include aseptic management of the airway, tracheostomy when indicated, adequate pain relief, and early mobilization. When the incipient signs of pneumonia appear, prompt aggressive antimicrobial therapy is indicated.