Abstract
Hospital-acquired pneumonia in the postoperative or trauma patient is a common and
troublesome complication. A variety of patient factors such as smoking, chronic obstructive
pulmonary disease (COPD), morbid obesity, and poor overall medical condition, along
with therapeutic interventions such as abdominal and thoracic operations, the need
for prolonged intubation and mechanical ventilation, and postoperative changes in
respiratory mechanics increase the risk for nosocomial pneumonia in surgical patients.
Establishing the diagnosis of hospital-acquired pneumonia in this group of patients
is notoriously difficult, since systemic signs of inflammation and radiographic changes
of atelectasis or chest trauma that mimic infectious infiltrates are common. Early-onset
and late-onset pneumonia in these patients have different associated risk factors,
microbiology, and prognosis. Late-onset pneumonia in both postoperative and trauma
patients is associated with significant mortality. A variety of preventive measures
such as selective digestive decontamination, continuous postural oscillation, and
preoperative respiratory muscle training may be beneficial in selected circumstances.
Key Words:
pneumonia - nosocomial - trauma - selective digestive decontamination
