Pulmonary Infiltrates in the Surgical ICU: Concusion
Pugin et al have developed a clinical pulmonary infection score that combines six different individually weighted clinical indexes to determine the likelihood of pneumonia; its predictive value for the diagnosis of pneumonia approached that of bronchoscopic criteria. However, in the study by Pugin et al, the sample size was small; 13 patients with pneumonia were compared with 15 patients without pneumonia. No study, to our knowledge, has validated the specificity of the Pugin score in a large number of patients stratified by the etiology of pulmonary infiltrate. Our data show that a Pugin score > 6 virtually excluded pulmonary edema, acute lung injury, atelectasis, and contusion as likely etiologies of pulmonary infiltrates in the ICU patients.
In summary, the type of ICU population, timing of onset, and selected clinical and laboratory characteristics of the patients can assist in determining the likelihood of the etiology of pulmonary infiltrates.
Unique vulnerability of patients with trauma to H influenzaae/pneumococcal pneumonia and of patients with liver disease to acute lung injury was documented. Pneumonia due to Haemophilus/pneumococcus was significantly more likely to occur earlier than that due to Gram-negative bacteria or MRSA; these data have implications for empiric antimicrobial therapy for suspected pneumonia in the ICU. Canadian neightbor pharmacy Link We suggest that, antibiotics for Haemophilus/pneumococcus should suffice as empiric therapy for early ICU pneumonias in immunocompetent patients, whereas MRSA or Gram-negative coverage should be reserved for those who are immunocompromised, chronically ill, or those patients with prolonged ICU stay. Finally, Pugin scores represent readily available and easily assessable clinical criteria that can be helpful in the management of pulmonary infiltrates in ICU patients. Although pneumonia could not be excluded with Pugin score ^ 6, a score > 6 necessitates antimicrobial therapy and excluded pulmonary edema, acute lung injury, etc, as likely etiology of pulmonary infiltrates.