Pneumonia in Trauma Patients

Schellenberg, Morgan; Inaba, Kenji

doi:10.1007/s40719-017-0105-z

Cited by 9 publications

(6 citation statements)

References 55 publications

(52 reference statements)

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“…Several others have reported both early- and late-onset pneumonia in traumatically injured patients without head trauma however these works do show that both thoracic trauma and major abdominal trauma are risk factors for the development of pneumonia 17 . Recently, Kenji Inaba’s group evaluated the nonmodifiable risk factors for pneumonia in polytrauma patients included traumatic brain injury (TBI), chest trauma, in addition to high Injury Severity Score (ISS), male sex, high ISS, and laparotomy 18 . We chose to use an extrathoracic model of polytrauma to more clearly evaluate the immune systems role in posttraumatic pneumonia rather than a model, which included pulmonary trauma that might skew the results and make it unclear what damage was caused by the injury, the immune response or the bacterial pneumonia.…”

mentioning

confidence: 99%

Extrathoracic multiple trauma dysregulates neutrophil function and exacerbates pneumonia-induced lung injury

Leonard

Zhang

Lü

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND: Forty percent of critically ill trauma patients will develop an infectious complication. Pneumonia is the most common cause of death of trauma patients surviving their initial insult. We previously demonstrated that polytrauma (PT), defined as two or more severe injuries in at least two areas of the body, induces emergency hematopoiesis characterized by accelerated myelopoiesis in the bone marrow and increased myeloid cell frequency in the peripheral tissues. We hypothesized that PT alone induces priming of neutrophils, resulting in hyperactivation upon secondary exposure to bacteria and causing acute lung injury and increased susceptibility to secondary exposure to Pseudomonas aeruginosa pneumonia. METHODS:C57BL/6 mice were subjected to PT consisting of a lower extremity pseudofracture, liver crush injury, and 15% blood-volume hemorrhage. Pneumonia was induced by intratracheal injection of 5 Â 106 CFU live P. aeruginosa or 1 Â 107 of heat-killed P. aeruginosa (HKPA). For reactive oxygen species (ROS), studies polymorphonuclear neutrophils (PMNs) were isolated by immunomagnetic bead negative selection and stimulated ex-vivo with HKPA. Reactive oxygen species production was measured by immunofluorescence. For histology, lung sections were stained by hematoxylin-eosin and analyzed by a blinded grader. RESULTS:Polytrauma induced persistent changes in immune function at baseline and to secondary infection. Pneumonia after injury resulted in increased mortality (60% vs. 5% p < 0.01). Blood neutrophils from PT mice had higher resting (unstimulated) ROS production than in naive animals (p < 0.02) demonstrating priming of the neutrophils following PT. After intratracheal HKPA injection, bronchoalveolar lavage PMNs from injured mice had higher ROS production compared with naive mice (p < 0.01), demonstrating an overexuberant immunopathologic response of neutrophils following PT. CONCLUSION: Polytrauma primes neutrophils and causes immunopathologic PMN ROS production, increased lung injury and susceptibility to secondary bacterial pneumonia. These results suggest that trauma-induced immune dysfunction can cause immunopathologic response to secondary infection and suggests neutrophil-mediated pulmonary damage as a therapeutic target for posttrauma pneumonia.

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confidence: 99%

Extrathoracic multiple trauma dysregulates neutrophil function and exacerbates pneumonia-induced lung injury

Leonard

Zhang

Lü

et al. 2021

J Trauma Acute Care Surg

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“…The joint guideline from the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) weakly recommends non-invasive sampling based on low-quality evidence, while in trauma patients the utility of mini-BAL has been demonstrated specifically in its ability to parse the diagnosis of pneumonia from acute respiratory distress syndrome (ARDS). 44 We recommend institutional multidisciplinary review of accepted practices and verification of correct interpretation based on techniques used.…”

Section: Discussionmentioning

confidence: 99%

Fever and infections in surgical intensive care: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document

Nohra,

Appelbaum,

Farrell

et al. 2024

Trauma Surg Acute Care Open

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The evaluation and workup of fever and the use of antibiotics to treat infections is part of daily practice in the surgical intensive care unit (ICU). Fever can be infectious or non-infectious; it is important to distinguish between the two entities wherever possible. The evidence is growing for shortening the duration of antibiotic treatment of common infections. The purpose of this clinical consensus document, created by the American Association for the Surgery of Trauma Critical Care Committee, is to synthesize the available evidence, and to provide practical recommendations. We discuss the evaluation of fever, the indications to obtain cultures including urine, blood, and respiratory specimens for diagnosis of infections, the use of procalcitonin, and the decision to initiate empiric antibiotics. We then describe the treatment of common infections, specifically ventilator-associated pneumonia, catheter-associated urinary infection, catheter-related bloodstream infection, bacteremia, surgical site infection, intra-abdominal infection, ventriculitis, and necrotizing soft tissue infection.

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“…Hasta el momento el rendimiento diagnóstico de los test microbiológicos en mini LBA a ciegas se comparó con el del aspirado traqueal y LBA en tuberculosis pulmonar, 9,10 neumonía asociada al ventilador 11,12 y neumonía asociada a los cuidados de salud. 13 Todos los trabajos coinciden en que el mini LBA a ciegas tiene un rendimiento igual o incluso mayor que el método con el que se comparó.…”

Section: Discussionunclassified

Concordancia del antígeno de galactomanano en lavado broncoalveolar broncoscópico y mini lavado broncoalveolar a ciegas

et al. 2022

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Introducción: las neumonías virales aumentan la susceptibilidad de sobreinfecciones fúngicas. Con la pandemia COVID-19, se reportaron múltiples casos de aspergilosis pulmonar invasiva asociada a CO-VID-19 (CAPA), lo que aumentó la mortalidad. No se recomienda realizar broncoscopía cursando CO-VID-19 dado el riesgo de aerosolización. Surgen entonces nuevas técnicas como el mini lavado broncoalveolar (LBA) a ciegas. Al no existir puntos de corte para la positividad del antígeno de galactomanano (GM) en muestras respiratorias no obtenidas por broncoscopía, surge la necesidad de validar la medición de GM en muestras obtenidas mediante mini LBA a ciegas.Objetivo: valorar la concordancia de medición de GM en muestras respiratorias obtenidas mediante mini LBA a ciegas y LBA por broncoscopia.Materiales y métodos: realizamos un estudio prospectivo, observacional y analítico, incluyendo pacientes ingresados en cuidados intensivos con sospecha de CAPA, que requirieron obtención de muestras respiratorias para estudio de GM. En todos se obtuvieron muestras de LBA y mini LBA a ciegas en un mismo procedimiento. Se consideró positivo GM mayor a 1.Resultados: se estudiaron 11 pacientes, se diagnosticaron 6 (54.5%) casos positivos para CAPA mediante LBA broncoscópico. La sensibilidad del mini LBA fue 33% y la especificidad 100%; valor predictivo positivo 100% y valor predictivo negativo 55%. El coeficiente de correlación de concordancia fue de 0,28 (IC -0,078 a 0,57), lo que mostró pobre concordancia entre ambos métodos.Conclusiones: el test de GM por mini LBA podría resultar un buen método confirmatorio, mientras que un resultado negativo no descarta CAPA.

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Pneumonia in Trauma Patients

Cited by 9 publications

References 55 publications

Extrathoracic multiple trauma dysregulates neutrophil function and exacerbates pneumonia-induced lung injury

Extrathoracic multiple trauma dysregulates neutrophil function and exacerbates pneumonia-induced lung injury

Fever and infections in surgical intensive care: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document

Concordancia del antígeno de galactomanano en lavado broncoalveolar broncoscópico y mini lavado broncoalveolar a ciegas

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