Early Onset Pneumonia

Background Early onset pneumonia occurs frequently in head trauma patients, but the potential consequences and the risk factors of this event have been poorly studied. Methods This prospective observational study was undertaken in the surgical intensive care unit of a university teaching hospital in Clichy, France. Head trauma patients requiring tracheal intubation for neurologic reasons and ventilation for at least 2 days were studied to assess the risk factors and the consequences of early onset pneumonia. Results During a 2-yr period, 109 head trauma patients were studied. The authors found an incidence of early onset pneumonia of 41.3%. Staphylococcus aureus was the most common bacteria involved in early onset pneumonia. Patients with early onset pneumonia had a lower worst arterial oxygen tension:fraction of inspired oxygen ratio, more fever, more arterial hypotension, and more intracranial hypertension, factors known to worsen the neurologic prognosis of head trauma patients. Nasal carriage of S. aureus on admission (odds ratio, 5.1; 95% confidence interval, 1.9-14.0), aspiration before intubation (odds ratio, 5.5; 95% confidence interval, 1.9-16.4) and barbiturate use (odds ratio, 3.9; 95% confidence interval, 1.2-12.8) were found to be independent risk factors of early onset pneumonia. Conclusions The results suggest that early onset pneumonia leads to secondary injuries in head-injured patients. Nasal carriage of S. aureus, aspiration before intubation, and use of barbiturates are specific independent risk factors for early onset pneumonia and must be assessed to find and evaluate strategies to prevent early onset pneumonia.

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Retrospective Analysis of the Risk Factors and Pathogens Associated With Early-onset Ventilator-associated Pneumonia in Surgical-ICU Head-trauma Patients

Journal of Neurosurgical Anesthesiology ◽

10.1097/ana.0b013e3181bdf52f ◽

2010 ◽

Vol 22 (1) ◽

pp. 32-37 ◽

Cited By ~ 40

Author(s):

Didier Lepelletier ◽

Antoine Roquilly ◽

Dominique Demeure dit latte ◽

Pierre Joachim Mahe ◽

Olivier Loutrel ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Analysis ◽

Head Trauma ◽

Early Onset ◽

Trauma Patients ◽

Ventilator Associated Pneumonia ◽

Surgical Icu

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Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study

Journal of Intensive Care ◽

10.1186/s40560-019-0425-x ◽

2020 ◽

Vol 8 (1) ◽

Cited By ~ 3

Author(s):

Aurélien Culver ◽

Benjamin Coiffard ◽

François Antonini ◽

Gary Duclos ◽

Emmanuelle Hammad ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Body Temperature ◽

Mortality Rate ◽

Head Trauma ◽

Core Body Temperature ◽

Trauma Patients ◽

Single Center ◽

Independent Risk Factors ◽

Core Body

Abstract Background Circadian clock alterations were poorly reported in trauma patients, although they have a critical role in human physiology. Core body temperature is a clinical variable regulated by the circadian clock. Our objective was to identify the circadian temperature disruption in trauma patients and to determine whether these disruptions were associated with the 28-day mortality rate. Methods A retrospective and observational single-center cohort study was conducted. All adult severe trauma patients admitted to the intensive care unit of Aix Marseille University, North Hospital, from November 2013 to February 2018, were evaluated. The variations of core body temperature for each patient were analyzed between days 2 and 3 after intensive care unit admission. Core body temperature variations were defined by three parameters: mesor, amplitude, and period. A logistic regression model was used to determine the variables influencing these three parameters. A survival analysis was performed assessing the association between core body temperature rhythm disruption and 28-day mortality rate. A post hoc subgroup analysis focused on the patients with head trauma. Results Among the 1584 screened patients, 248 were included in this study. The period differed from 24 h in 177 (71%) patients. The mesor value (°C) was associated with body mass index and ketamine use. Amplitude (°C) was associated with ketamine use only. The 28-day mortality rate was 18%. For all trauma patients, age, body mass index, intracranial hypertension, and amplitude were independent risk factors. The patients with a mesor value < 36.9 °C (p < 0.001) and an amplitude > 0.6 °C (p < 0.001) had a higher 28-day mortality rate. Among the patients with head trauma, mesor and amplitude were identified as independent risk factors (HR = 0.40, 95% CI [0.23–0.70], p = 0.001 and HR = 4.73, 95% CI [1.38–16.22], p = 0.01). Conclusions Our results highlight an association between core body temperature circadian alteration and 28-day mortality rate. This association was more pronounced in the head trauma patients than in the non-head trauma patients. Further studies are needed to show a causal link and consider possible interventions.

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Mild to Moderate to Severe: What Drives the Severity of ARDS in Trauma Patients?

The American Surgeon ◽

10.1177/000313481808400623 ◽

2018 ◽

Vol 84 (6) ◽

pp. 808-812 ◽

Cited By ~ 1

Author(s):

Pamela Daher ◽

Pedro G. Teixeira ◽

Thomas B. Coopwood ◽

Lawrence H. Brown ◽

Sadia Ali ◽

...

Keyword(s):

Risk Factors ◽

Chest Trauma ◽

Surgical Intensive Care Unit ◽

Trauma Patients ◽

Surgical Intensive Care ◽

Total Blood ◽

Factors Associated ◽

Severity Of Disease ◽

Chest Injuries ◽

Independent Risk Factors

Acute respiratory distress syndrome (ARDS) is a complex inflammatory process with multifactorial etiologies. Risk factors for its development have been extensively studied, but factors associated with worsening severity of disease, as defined by the Berlin criteria, are poorly understood. A retrospective chart and trauma registry review identified trauma patients in our surgical intensive care unit who developed ARDS, defined according to the Berlin definition, between 2010 and 2015. The primary outcome was development of mild, moderate, or severe ARDS. A logistic regression model identified risk factors associated with developing ARDS and with worsening severity of disease. Of 2704 total patients, 432 (16%) developed ARDS. Of those, 100 (23%) were categorized as mild, 176 (41%) as moderate, and 156 (36%) as severe. Two thousand two hundred and seventy-two patients who did not develop ARDS served as controls. Male gender, blunt trauma, severe head and chest injuries, and red blood cell as well as total blood product transfusions are independent risk factors associated with ARDS. Worsening severity of disease is associated with severe chest trauma and volume of plasma transfusion. Novel findings in our study include the association between plasma transfusions and specifically severe chest trauma with worsening severity of ARDS in trauma patients.

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Risk factors for mortality in patients undergoing continuous renal replacement therapy after cardiac surgery

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02324-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chang Liu ◽

Hai-Tao Zhang ◽

Li-Jun Yue ◽

Ze-Shi Li ◽

Ke Pan ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Cardiac Surgery ◽

Renal Replacement Therapy ◽

Confidence Interval ◽

Hospital Mortality ◽

Odds Ratio ◽

Intraoperative Bleeding ◽

Independent Risk Factors ◽

Mechanical Ventilation Time

Abstract Background To investigate the risk factors for mortality in patients with acute kidney injury requiring continuous renal replacement therapy (AKI-CRRT) after cardiac surgery. Methods In this retrospective study, patients who underwent AKI-CRRT after cardiac surgery in our centre from January 2015 to January 2020 were included. Univariable and multivariable analyses were performed to identify the risk factors for in-hospital mortality. Results A total of 412 patients were included in our study. Of these, 174 died after AKI-CRRT, and the remaining 238 were included in the survival control group. Multivariable logistic regression analysis revealed that EuroSCORE > 7 (odds ratio [OR], 3.72; 95% confidence interval [CI], 1.92–7.24; p < 0.01), intraoperative bleeding > 1 L (OR, 2.14; 95% CI, 1.19–3.86; p = 0.01) and mechanical ventilation time > 70 h (OR, 5.03; 95% CI, 2.40–10.54; p < 0.01) were independent risk factors for in-hospital mortality in patients who had undergone AKI-CRRT. Our study also found that the use of furosemide after surgery was a protective factor for such patients (odds ratio, 0.48; 95% confidence interval, 0.25–0.92; p = 0.03). Conclusions In summary, the mortality of patients with AKI-CRRT after cardiac surgery remains high. The EuroSCORE, intraoperative bleeding and mechanical ventilation time were independent risk factors for in-hospital mortality. Continuous application of furosemide may be associated with a better outcome.

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Risk Factors of Bacteremia following Multiple Traumas

Emergency Medicine International ◽

10.1155/2020/9217949 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Hak-Jae Lee ◽

Eol Choi ◽

Nak-Joon Choi ◽

Hyun-Woo Sun ◽

Jae-Suk Lee ◽

...

Keyword(s):

Risk Factors ◽

Gastrointestinal Tract ◽

Early Onset ◽

Massive Transfusion ◽

Late Onset ◽

Surgical Intensive Care Unit ◽

Trauma Patients ◽

Gram Positive ◽

Tract Perforation ◽

Gram Positive Cocci

Background. Bacteremia is a major nosocomial infection that frequently occurs in trauma patients, increasing morbidity and mortality. The aim of this study was to identify risk factors and to describe epidemiological patterns for early onset (EOB) and late onset (LOB) bacteremia after trauma. Methods. We retrospectively reviewed medical records of all trauma patients admitted to the surgical intensive care unit and general ward between January 2011 and December 2015. The information was collected for each patient and recorded in a computer database: early onset bacteremia (EOB) was defined as when onset occurred within 7 days after trauma, and late onset bacteremia (LOB) was defined as when onset occurred after 7 days from trauma. Results. Thirty-four patients of 859 (4%) developed bacteremia during their hospital stay: 4 (11.8%) developed EOB, 26 (76.4%) LOB, and 4 (11.8%) patients developed both of them. Sixty events of bacteremia happened to these patients: 9 (15.0%) EOB and 51 (85.0%) LOB. Gram-positive cocci were isolated more frequently than Gram-negative bacilli in both groups. Gram-positive cocci were more frequently isolated in EOB than in LOB; otherwise, there was no statistical significance (77.8% vs. 64.7%, p=0.683). Central line-associated blood stream infection (CLABSI) and surgical site infection (SSI) were the most common identified source for LOB. Presence of liver (OR: 2.66, p=0.035) and pelvic injury (OR: 2.25, p=0.038), gastrointestinal tract perforation (OR: 5.48, p=0.002), and massive transfusion (OR: 3.36, p=0.006) represented risk factors for bacteremia. Conclusions. Presence of pelvic and liver injury on arrival in emergency department, gastrointestinal tract perforation, and massive transfusion within the first 24 hours after trauma appears to be significant risk factors for bacteremia.

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Risk Factors for Early-onset, Ventilator-associated Pneumonia in Critical Care Patients

Anesthesiology ◽

10.1097/00000542-200009000-00011 ◽

2000 ◽

Vol 93 (3) ◽

pp. 638-645 ◽

Cited By ~ 55

Author(s):

Ozan Akça ◽

Kemalettin Koltka ◽

Serdar Uzel ◽

Nahit Çakar ◽

Kamil Pembeci ◽

...

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Glasgow Coma Score ◽

Early Onset ◽

Odds Ratio ◽

Late Onset ◽

Multidrug Resistant ◽

Ventilator Associated Pneumonia ◽

Clinical Criteria ◽

Potential Risk Factors

Background Ventilator-associated pneumonia is the leading nosocomial infection in critically ill patients. The frequency of ventilator-associated pneumonia caused by multidrug-resistant bacteria has increased in recent years, and these pathogens cause most of the deaths attributable to pneumonia. The authors, therefore, evaluated factors associated with selected multidrug-resistant ventilator-associated pneumonia in critical care patients. Methods The authors prospectively recorded potential risk factors at the time of intensive care unit admission. An endotracheal aspirate was obtained in all patients who met clinical criteria for pneumonia. Patients were considered to have ventilator-associated pneumonia only when they met the clinical criteria and aspirate culture was positive for bacteria 48 h or more after initiation of mechanical ventilation. Pediatric patients were excluded. Adult patients with ventilator-associated pneumonia were first grouped as "early-onset" (< 5 days) and "late-onset," determined by episodes of ventilator-associated pneumonia, and then, assigned to four groups based on the bacteria cultured from their tracheal aspirates: Pseudomonas aeruginosa, Acinetobacter baumanii, methicillin-resistant staphylococci, and all others. The first three bacteria were considered to be multidrug resistant, whereas the others were considered to be antibiotic susceptible. Potential risk factors were evaluated with use of univariate statistics and multivariate regression. Results Among 486 consecutive patients admitted during the study, 260 adults underwent mechanical ventilation for more than 48 h. Eighty-one patients (31%) experienced 99 episodes of ventilator-associated pneumonia, including Pseudomonas(33 episodes), methicillin-resistant staphylococci (17 episodes), Acinetobacter(9 episodes), and nonresistant bacteria (40 episodes). Sixty-six of these episodes were early onset and 33 episodes were late onset. Logistic regression analysis identified three factors significantly associated with early-onset ventilator-associated pneumonia caused by any one of the multidrug-resistant bacterial strains: emergency intubation (odds ratio, 6.4; 95% confidence interval, 2.0-20.2), aspiration (odds ratio, 12.7; 95% confidence interval, 2.4-64.6), and Glasgow coma score of 9 or less (odds ratio, 3.9; 95% confidence interval, 1.3-11.3). A. baumanii-related pneumonia cases were found to be significantly associated with two of these factors: aspiration (odds ratio, 14.2; 95% confidence interval, 1.5-133.8) and Glasgow coma score (odds ratio, 6.0; 95% confidence interval, 1.1-32.6). Conclusions The authors recommend that patients undergoing emergency intubation or aspiration or who have a Glasgow coma score of 9 or less be monitored especially closely for early-onset multidrug-resistant pneumonia. The occurrence of aspiration and a Glasgow coma score of 9 or less are especially associated with pneumonia caused by A. baumanii.

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Analysis of factors associated with prolonged post-operative course after surgical repair of aortic coarctation

Cardiology in the Young ◽

10.1017/s1047951120003637 ◽

2020 ◽

pp. 1-8

Author(s):

Santosh Kaipa ◽

Mouhammad Yabrodi ◽

Brian D. Benneyworth ◽

Eric S. Ebenroth ◽

Christopher W. Mastropietro

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Confidence Interval ◽

Odds Ratio ◽

Aortic Coarctation ◽

Patient Characteristics ◽

Oral Feeding ◽

Prolonged Length ◽

Independent Risk Factors ◽

Neonates And Infants

Abstract Objective: We sought to describe patient characteristics associated with prolonged post-operative length of stay in a contemporary cohort of infants who underwent isolated repair of aortic coarctation. Methods: We reviewed patients less than 1 year of age who underwent isolated repair of aortic coarctation at our institution from 2009 to 2016. Prolonged post-operative length of stay was defined as length of stay within the upper tertile for the cohort. Bivariate and multi-variable analyses were performed to determine independent risk factors for prolonged length of stay. Results: We reviewed 95 consecutive patients who underwent isolated repair of aortic coarctation, of whom 71 were neonates at the time of diagnosis. The median post-operative length of stay was 6.5 days. The upper tertile for post-operative length of stay was greater than 10 days; 32 patients within this tertile and 1 patient who died at 8.5 days after surgery were analysed as having prolonged post-operative length of stay. In a multi-variable analysis, pre-maturity (odds ratio: 3.5, 95% confidence interval: 1.2, 10.7), genetic anomalies (odds ratio: 4.7, 95% confidence interval: 1.2, 18), absence of pre-operative oral feeding (odds ratio: 7.4, 95% confidence interval: 2.4, 22.3), and 12-hour vasoactive-ventilation-renal score greater than 25 (odds ratio: 7.4, 95% confidence interval: 1.9, 29) were independently associated with prolonged length of stay. Conclusions: In neonates and infants who underwent isolated repair of aortic coarctation, pre-maturity, genetic anomalies, lack of pre-operative oral feedings, and 12-hour vasoactive-ventilation-renal score more than 25 were independent risk factors for prolonged post-operative length of stay. Further study on the relationship between pre-operative oral feedings and post-operative length of stay should be pursued.

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Relation between Cardiac Injury and Elevated Levels with Severe COVID-19 of Inflammatory Biomarkers in Patients

Cardiovascular Innovations and Applications ◽

10.15212/cvia.2019.1264 ◽

2020 ◽

Author(s):

Jing Li

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Confidence Interval ◽

Odds Ratio ◽

Cardiac Injury ◽

High Sensitivity ◽

Inflammatory Biomarkers ◽

Health Crisis ◽

Independent Risk Factors ◽

The Relationship

Background: Since early December 2019, coronavirus disease 2019 (COVID-19) has emerged as a global pandemic and public health crisis. This study aims to explore the relationship between cardiac injury and inflammatory biomarkers in patients with severe COVID-19.Methods: We collected data on 91 patients with a confirmed diagnosis of severe COVID-19 from February 8 to March 31, 2020. Demographic characteristics, clinical data, and in-hospital outcomes were compared. The relationship between cardiac injury and inflammatory biomarkers was analyzed. Logistic regression was used to explore the independent risk factors for cardiac injury.Results: The mean age of all patients was 61 years ± 14 years. About half of the patients were male. Hypertension and coronary heart disease were more common in the cardiac injury group. The levels of inflammatory biomarkers in patients who experienced cardiac injury were generally higher than the levels of those without cardiac injury, including interleukin-6, interleukin-2 receptor (IL-2R), procalcitonin, and high-sensitivity C-reactive protein. There were positive correlations between the levels of high-sensitivity troponin I and N-terminal prohormone of brain natriuretic peptide and the levels of inflammatory biomarkers. Logistic regression shows that IL-2R (odds ratio 1.001, 95% confidence interval 1.000–1.002, P = 0.045) and comorbidities (odds ratio 4.909, 95% confidence interval 1.231–19.579, P = 0.024)are independent risk factors for cardiac injury in patients with severe COVID-19.Conclusion: High levels of inflammatory biomarkers are associated with higher risk of cardiac injury in patients withsevere COVID-19. IL-2R and comorbidities are predictors of cardiac injury.

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Parental risk factors for congenital diaphragmatic hernia – a large German case-control study

BMC Pediatrics ◽

10.1186/s12887-021-02748-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Felicitas Schulz ◽

Ekkehart Jenetzky ◽

Nadine Zwink ◽

Charlotte Bendixen ◽

Florian Kipfmueller ◽

...

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Environmental Risk ◽

Odds Ratio ◽

Alcohol Intake ◽

Case Control Study ◽

Case Control ◽

Parental Risk Factors ◽

Healthy Control ◽

Control Study

Abstract Background Evidence for periconceptional or prenatal environmental risk factors for the development of congenital diaphragmatic hernia (CDH) is still scarce. Here, in a case-control study we investigated potential environmental risk factors in 199 CDH patients compared to 597 healthy control newborns. Methods The following data was collected: time of conception and birth, maternal BMI, parental risk factors such as smoking, alcohol or drug intake, use of hairspray, contact to animals and parental chronic diseases. CDH patients were born between 2001 and 2019, all healthy control newborns were born in 2011. Patients and control newborns were matched in the ratio of three to one. Results Presence of CDH was significantly associated with maternal periconceptional alcohol intake (odds ratio = 1.639, 95% confidence interval 1.101–2.440, p = 0.015) and maternal periconceptional use of hairspray (odds ratio = 2.072, 95% confidence interval 1.330–3.229, p = 0.001). Conclusion Our study suggests an association between CDH and periconceptional maternal alcohol intake and periconceptional maternal use of hairspray. Besides the identification of novel and confirmation of previously described parental risk factors, our study underlines the multifactorial background of isolated CDH.

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Age and multimorbidities as poor prognostic factors for COVID-19 in hemodialysis: a Lebanese national study

BMC Nephrology ◽

10.1186/s12882-021-02270-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Mabel Aoun ◽

Rabab Khalil ◽

Walid Mahfoud ◽

Haytham Fatfat ◽

Line Bou Khalil ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Coronary Artery Disease ◽

Confidence Interval ◽

Odds Ratio ◽

Death Rate ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

National Study ◽

Artery Disease

Abstract Background Hemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients. Methods This is an observational study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients’ medical records. A binary logistic regression analysis was performed to assess risk factors for mortality. Results A total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio = 1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio = 4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio = 3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio = 1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio = 6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio = 4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio = 19.18; 95% confidence interval: 6.47, 56.83). Conclusions This national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.

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