Reduced gastric acid in the intubated intensive care unit patients may result from intrinsic disease of gastric acid production or from the use of antacids or histamine type 2-blockers which neutralize or block gastric acid secretion. Correlation between levels of bacteria in the gastric juice and treatment of patients with peptic ulcer disease with cimetidine [...]

Dr. Craven: When a patient is mechanically ventilated, the lower respiratory tract may become colonized more readily with bacteria. In the 1960s, the Dallas group reported that ventilators with contaminated mainstream nebulizers could generate bacterial aero­sols that infiltrated the terminal bronchioles and alveoli, resulting in a necrotizing Gram-negative pneu­monia. Most ventilators now heat and humidify [...]

Gram-negative bacilli, such as Escherichia colt, Klebsiella pneumoniae, and Pseudomonas aeruginosa are the most common types of bacteria causing noso­comial pneumonia. Staphylococcus aureus, which can be methicillin-sensitive or resistant, accounts for a large portion of hospital-acquired pneumonia in some hospitals. Nosocomial pneumonia due to Le­gionella pneumophila has been reported in certain geographic areas such as [...]

In studies of bacterial adherence, there has been the consistent observation, in normal individuals and in critically ill patients, that tracheal cells have a greater capacity to bind Pseudomonas aeruginosa than do buccal epithelial cells. The clinical relevance of these findings may relate to the occurrence of tissue “tropisms,” or preferences, of Pseudomonas aeruginosa in [...]

The patient discussed today has multiple risk factors for both upper and lower airway colonization (Table 1). These included his serious degree of underlying illness, recent surgery, the use of multiple antibiotics, endotracheal intubation and tracheostomy, malnutri­tion, the use of corticosteroids, recurrent hypotensive episodes, and the use of histamine type-2 receptor blocking agents for the [...]

In many studies, the measurement of plasma factors to predict ARDS has been disappointing. While various components of activated complement are elevated in septic patients, none has been shown to consistently predict progressive lung injury. Re-cently, a prospective study by Langlois and Gawryl demonstrated the terminal complement complex was increased by an average of 100 [...]

Approximately one week after discharge from the intensive care unit, the patient again developed dyspnea, cough productive of green sputum, and fever to 38.3°C. A repeat chest radiograph (Fig 3) demonstrated persistent infiltrates in the right chest along with specimen brush was repeated and again Pseudomonas aeruginosa was recovered in greater than 104 organisms per [...]