PULMONARY-INFILTRATES IN THE SURGICAL ICU - PROSPECTIVE ASSESSMENT OFPREDICTORS OF ETIOLOGY AND MORTALITY

A prospective cohort study of 129 consecutive patients developing pulm onary infiltrates in the surgical ICU was conducted to determine the p redictors and outcome of pulmonary infiltrates. Most common etiologies of pulmonary infiltrates were pneumonia (30%), pulmonary edema (29%), acute lung injury (15%), and atelectasis (13%). Enteral nutrition was associated with a significantly lower incidence of acute lung injury as compared with pneumonia (22% vs 58%, p = 0.012). Patients with live r disease were significantly more likely to have pulmonary infiltrates due to acute lung injury as compared with other etiologies (p = 0.02) . Clinical pulmonary infection score (Pugin score) > 6 virtually exclu ded acute lung injury, pulmonary edema, or atelectasis as etiologies o f pulmonary infiltrates. Nosocomial Haemophilus/pneumococcal pneumonia occurred significantly earlier in the ICU as compared with Gram-negat ive (p = 0.05) or methicillin-resistant Staphylococcus aureus pneumoni a (p = 0.01). Pneumonia in trauma patients was significantly more like ly to be due to Haemophilus/pneumococcus as compared with all other IC U patients (54% vs 0%, p = 0.0004), These data have implications for t reatment of patients with nosocomial pneumonia in the ICU.