Risk factors for ventilator-associated pneumonia in trauma patients: A descriptive analysis

被引:46
作者
Arumugam, Suresh Kumar [1 ]
Mudali, Insolvisagan [1 ]
Strandvik, Gustav [1 ]
El-Menyar, Ayman [2 ,3 ]
Al-Hassani, Ammar [1 ]
Al-Thani, Hassan [1 ]
机构
[1] Hamad Gen Hosp, Dept Surg, Trauma Surg Sect, Doha, Qatar
[2] Hamad Gen Hosp, Trauma Surg Sect, Clin Res, Doha, Qatar
[3] Weill Cornell Med Coll, Med Clin, Doha, Qatar
关键词
Ventilator-associated pneumonia; Trauma; Mechanical ventilation; Intubation location; Intensive care unit; EARLY-ONSET PNEUMONIA; PREHOSPITAL INTUBATION; MORTALITY; SAFETY;
D O I
10.5847/wjem.j.1920-8642.2018.03.007
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND: We sought to evaluate the risk factors for developing ventilator-associated pneumonia (VAP) and whether the location of intubation posed a risk in trauma patients. METHODS: Data were retrospectively reviewed for adult trauma patients requiring intubation for > 48 hours, admitted between 2010 and 2013. Patients' demographics, clinical presentations and outcomes were compared according to intubation location (prehospital intubation [PHI] vs. trauma room [TRI]) and presence vs. absence of VAP. Multivariate regression analysis was performed to identify predictors of VAP. RESULTS: Of 471 intubated patients, 332 patients met the inclusion criteria (124 had PHI and 208 had TRI) with a mean age of 30.7 +/- 14.8 years. PHI group had lower GCS (P=0.001), respiratory rate (P= 0.001), and higher frequency of head (P=0.02) and chest injuries (P=0.04). The rate of VAP in PHI group was comparable to the TRI group (P=0.60). Patients who developed VAP were 6 years older, had significantly lower GCS and higher ISS, head AIS, and higher rates of polytrauma. The overall mortality was 7.5%, and was not associated with intubation location or pneumonia rates. In the early-VAP group, gram-positive pathogens were more common, while gram-negative microorganisms were more frequently encountered in the late VAP group. Logistic regression analysis and modeling showed that the impact of the location of intubation in predicting the risk of VAP appeared only when chest injury was included in the models. CONCLUSION: In trauma, the risk of developing VAP is multifactorial. However, the location of intubation and presence of chest injury could play an important role.
引用
收藏
页码:203 / 210
页数:8
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