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Pneumonia: cause or symptom of postinjury multiple organ failure?
A Sauaia1, F A Moore, E E Moore
1Department of Surgical, Denver General Hospital, Colarado 80204-4507.
Abstract:
Recent studies have shown that selective gut decontamination can reduce the incidence of pneumonia, but this does not decrease multiple organ failure (MOF) or mortality. These findings have prompted the hypothesis that pneumonia is an inconsequential symptom of MOF. To test this, we prospectively evaluated 123 high-risk trauma patients (mean Injury Severity Score = 36.2 +/- 1.5). Organ dysfunction, scored daily according to a 12-point scale, ultimately developed in 28 (23%) patients. Major infections were diagnosed, based on strict criteria, in 59 patients (48%), and pneumonia developed in 52 patients (43%). Pneumonia was significantly associated with MOF (82% of patients with MOF versus 30% of patients without MOF, p < 0.0001). In 14 (50%) of the patients with MOF, pneumonia preceded a significant rise (greater than or equal to 3) in serial MOF scoring. Of note, 10 (71%) of these patients died. Among the remaining 14 patients with MOF, 10 developed pneumonia, but this was associated with a minimal increase (less than or equal to 2) in MOF scoring (3 patients died). These data, by temporal association with MOF scoring, implicate pneumonia in precipitating or significantly worsening organ failure in 50% of the patients who developed MOF.
Insights
Pneumonia may precipitate or worsen multiple organ failure (MOF) in trauma patients. This study suggests pneumonia is not merely a symptom but a significant factor in MOF development and mortality.
Area of Science:
- Critical Care Medicine
- Trauma Surgery
- Infectious Disease Epidemiology
Background:
- Selective gut decontamination reduces pneumonia but not multiple organ failure (MOF) or mortality.
- This led to the hypothesis that pneumonia is an inconsequential symptom of MOF.
Purpose of the Study:
- To investigate the role of pneumonia in the development and progression of MOF in high-risk trauma patients.
Main Methods:
- Prospective evaluation of 123 high-risk trauma patients.
- Daily scoring of organ dysfunction using a 12-point scale.
- Diagnosis of major infections and pneumonia based on strict criteria.
Main Results:
- Pneumonia was significantly associated with MOF (82% vs. 30%, p < 0.0001).
- In 50% of MOF patients, pneumonia preceded a significant increase in MOF scores, with 71% mortality.
- Pneumonia in the other 50% of MOF patients was associated with minimal MOF score increases, and lower mortality.
Conclusions:
- Pneumonia implicates in precipitating or significantly worsening MOF in 50% of affected patients.
- Findings challenge the view of pneumonia as an inconsequential symptom in MOF.
- Pneumonia may be a critical factor in trauma patient outcomes, influencing MOF progression.