ICU Chest Films > Lung Processes > Pneumonia in the ICU

Pneumonia in the ICU

Nosocomial pneumonias by definition occur 3 days after admission. They differ from community-acquired pneumonias in both etiology and prognosis. Patients in the ICU are often relatively immunocompromised secondary to their primary disease and are subject to iatrogenic factors which increase their sucseptabilty to pneumonia-causing pathogens. These include the following: endotracheal tubes, which defeat many patient defense mechanisms; medications used to reduce gastric acid, which may promote bacterial growth in the stomach; and the use of antibiotics, which may selectively encourage the growth of some pathogenic bacteria. Nosocomial pneumonia presents a great concern for the intensivist and is the leading cause of infectious death in hospitals. Unlike community-acquired pneumonias, which usually are caused by gram-positive species, nosocomial pneumonias are often polymicrobial and caused by gram-negative enteric pathogens. The offending organisms often include Pseudomonas species, E-coli, Klebsiella species, and Proteus species. Traditional clinical indicators of pneumonia, including fever, elevated white blood cell count, and positive sputum cultures are often masked by severe underlying disease. The chest film must be correlated with clinical data inorder to make the diagnosis of pneumonia in the ICU patient.

In a supine patient who has aspirated, where are the common locations of pneumonia?
Posterior segment of upper lobe
Superior segment of lower lobe
Basilar segment of lower lobe
Apex