Hospital-acquired gram-negative pneumonia in critically ill, injured patients

Hospital-acquired gram-negative pneumonia is a major problem in critically ill, injured patients. The currently available therapeutic interventions to prevent the disease process are of limited usefulness. This most likely reflects an incomplete understanding of the complex pathophysiologic mechanism and thus invites examination of alternative mechanisms. We have hypothesized that the lung's response to traumatic injury may be driving the local organ injury by generating an early, local pulmonary cytokine production independent of the systemic cytokine response or the intensive care unit environment. Understanding the local pulmonary cytokine response to traumatic injury and its effect on the pulmonary airspace's immunologic contents may yield targeted and clinically relevant therapeutic interventions. Currently, the successful treatment of hospital-acquired gram-negative pneumonia depends on a clear and consistent definition of the disease process, knowledge that therapy with a single antibiotic is effective, and use of a concise treatment protocol that provides for reassessment of the patient when antibiotic therapy appears to be ineffective.