| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
Dr. Spain is Chief of Trauma/Surgical Clinical Care, Department of Surgery.
Correspondence to: David A. Spain, MD, Chief of Trauma/Surgical Clinical Care, Department of Surgery, Stanford University, 300 Pasteur Dr H3680, Stanford, CA 94303-5655; e-mail: dspain{at}stanford.edu
I suspect that many intensivists caring for patients with ventilator-associated pneumonia (VAP) would assume that patients with polymicrobial infections had worse outcomes, had a greater chance for inadequate empiric coverage, were more likely to have resistant organisms, etc. However, in the study by Combes et al (see page 1618), although almost half of their patients had polymicrobial VAP, no difference in outcomes was observed. The authors correctly point out that this may be due to the manner in which these patients arrived to them (ie, most were receiving mechanical ventilation at hospital admission, had significant underlying disease, and, most importantly, many were receiving antibiotic therapy at the time of diagnosis). Thus, the similar outcomes for patients with monomicrobial and polymicrobial pneumonia are not so surprisingly.
What struck me in reviewing this article was how little attention surgeons pay to the problem of VAP in our patients. The investigative group from Hôpital Bichat (Paris, France) as well as several others1 2 3 4 have provided a systematic inquiry into the complex problem of VAP. Most of these studies have focused on medical or mixed populations of critically ill patients and in the process have contributed to our knowledge of VAP in trauma and surgical patients. By comparison, VAP is an enormous problem in trauma patients requiring mechanical ventilation, especially if this condition is combined with a neurologic injury. The incidence of VAP may approach 50 to 80% in certain populations.5 6 Despite this, only a few surgical investigators5 6 7 8 have shown any interest in this problem. The proceedings of the first ever Pneumonia Summit held by surgeons were published in 2000.9 I hope that this modest attempt to call attention to the problem of VAP in surgical and trauma patients will lead to a thoughtful investigation similar to the one provided by our medical and pulmonary colleagues.
References
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
