TREATMENT OF PNEUMONIA IN MECHANICALLY VENTILATED TRAUMA PATIENTS - RESULTS OF A PROSPECTIVE TRIAL

Objectives: To determine the efficacy and magnitude of associated adve rse effects of 2 different antibiotic regimens for the treatment of pn eumonia in intubated surgical patients and to assay and compare blood samples and bronchoalveolar lavage fluid with respect to some host-def ense parameters, especially in patients with unilateral pneumonia. Des ign: Randomized, prospective, unblinded clinical comparison of 2 treat ment arms with respect to intent to treat and clinical and microbiolog ically evaluable patients. Setting: Six university surgical services i n teaching hospitals with modern and well-staffed intensive care units . Interventions: The consistency and objectivity of the diagnosis of p neumonia was improved by the use of a grid of diagnostic parameters. A ggressive mechanical approaches to pneumonia in intubated surgical pat ients were supplemented by therapeutic use of aztreonam and vancomycin hydrochloride or combined imipenem and cilastatin sodium. Results: Pa tients randomized to the aztreonam-vancomycin group were somewhat more ill, fared slightly better, and had fewer serious drug-related side e ffects than did those treated with imipenem-cilastatin (all P>.05). Im munologic parameters assessed by evaluation of bronchoalveolar lavage fluid showed differences between infected pulmonary lobes and noninfec ted ones; some changes were also noted in patients who recovered compa red with those whose pneumonia persisted or recurred. Conclusions: Cli nical studies of pneumonia in surgical patients need to be stratified to assure comparability, to identify patients in whom treatment is lik ely to fail, and to display differences between more and less effectiv e therapies. Studies of blood and bronchoalveolar lavage samples showe d that certain local and systemic immunologic parameters correlate wit h clinical status and outcome.