The Role of Infection in the Premature and Adult with Lung Injury

Nosocomial pneumonia is now recognized to be a significant cause of morbidity and mortality among infants and adults in intensive care units. It is a major threat to the patient with adult respiratory distress syndrome (ARDS). In our series of adult patients with acute respiratory failure, histologic evidence of bacterial pneumonia was found in the lungs of 74% of those who died and were autopsied [1]. Infants in ICU settings who succumb often have widespread pulmonary infection at autopsy [2]. In both the ventilator-dependent infant and adult, the use of systemic microbial therapy to eliminate pneumonias has proved difficult. This review will present observations from several studies that bear upon the problem of infection in bronchopulmonary dysplasia (BPD) and ARDS, the clinical expression of acute respiratory failure due to diffuse alveolar damage.