Lung function trajectories in children with post-prematurity respiratory disease: identifying risk factors for abnormal growth

Abstract Background Survivors of prematurity are at risk for abnormal childhood lung function. Few studies have addressed trajectories of lung function and risk factors for abnormal growth in childhood. This study aims to describe changes in lung function in a contemporary cohort of children born preterm followed longitudinally in pulmonary clinic for post-prematurity respiratory disease and to assess maternal and neonatal risk factors associated with decreased lung function trajectories. Methods Observational cohort of 164 children born preterm ≤ 32 weeks gestation followed in pulmonary clinic at Boston Children’s Hospital with pulmonary function testing. We collected demographics and neonatal history. We used multivariable linear regression to identify the impact of neonatal and maternal risk factors on lung function trajectories in childhood. Results We identified 264 studies from 82 subjects with acceptable longitudinal FEV1 data and 138 studies from 47 subjects with acceptable longitudinal FVC and FEV1/FVC data. FEV1% predicted and FEV1/FVC were reduced compared to childhood norms. Growth in FVC outpaced FEV1, resulting in an FEV1/FVC that declined over time. In multivariable analyses, longer duration of mechanical ventilation was associated with a lower rate of rise in FEV1% predicted and greater decline in FEV1/FVC, and postnatal steroid exposure in the NICU was associated with a lower rate of rise in FEV1 and FVC % predicted. Maternal atopy and asthma were associated with a lower rate of rise in FEV1% predicted. Conclusions Children with post-prematurity respiratory disease demonstrate worsening obstruction in lung function throughout childhood. Neonatal risk factors including exposure to mechanical ventilation and postnatal steroids, as well as maternal atopy and asthma, were associated with diminished rate of rise in lung function. These results may have implications for lung function trajectories into adulthood.

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The Impact of Intervention-Related Risk Factors on the Risk of Ventilator-Associated Pneumonia Is High in a Neurosurgical Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1059 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s407-s409

Author(s):

Ksenia Ershova ◽

Oleg Khomenko ◽

Olga Ershova ◽

Ivan Savin ◽

Natalia Kurdumova ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Negative Slope ◽

Infection Prevention And Control ◽

Ventilator Associated Pneumonia ◽

Related Factors ◽

Icu Patients ◽

The Impact ◽

Adf Test ◽

Over Time

Background: Ventilator-associated pneumonia (VAP) represents the highest burden among all healthcare-associated infections (HAIs), with a particularly high rate in patients in neurosurgical ICUs. Numerous VAP risk factors have been identified to provide a basis for preventive measures. However, the impact of individual factors on the risk of VAP is unclear. The goal of this study was to evaluate the dynamics of various VAP risk factors given the continuously declining prevalence of VAP in our neurosurgical ICU. Methods: This prospective cohort unit-based study included neurosurgical patients who stayed in the ICU >48 consecutive hours in 2011 through 2018. The infection prevention and control (IPC) program was implemented in 2010 and underwent changes to adopt best practices over time. We used a 2008 CDC definition for VAP. The dynamics of VAP risk factors was considered a time series and was checked for stationarity using theAugmented Dickey-Fuller test (ADF) test. The data were censored when a risk factor was present during and after VAP episodes. Results: In total, 2,957 ICU patients were included in the study, 476 of whom had VAP. Average annual prevalence of VAP decreased from 15.8 per 100 ICU patients in 2011 to 9.5 per 100 ICU patients in 2018 (Welch t test P value = 7.7e-16). The fitted linear model showed negative slope (Fig. 1). During a study period we observed substantial changes in some risk factors and no changes in others. Namely, we detected a decrease in the use of anxiolytics and antibiotics, decreased days on mechanical ventilation, and a lower rate of intestinal dysfunction, all of which were nonstationary processes with a declining trend (ADF testP > .05) (Fig. 2). However, there were no changes over time in such factors as average age, comorbidity index, level of consciousness, gender, and proportion of patients with brain trauma (Fig. 2). Conclusions: Our evidence-based IPC program was effective in lowering the prevalence of VAP and demonstrated which individual measures contributed to this improvement. By following the dynamics of known VAP risk factors over time, we found that their association with declining VAP prevalence varies significantly. Intervention-related factors (ie, use of antibiotics, anxiolytics and mechanical ventilation, and a rate of intestinal dysfunction) demonstrated significant reduction, and patient-related factors (ie, age, sex, comorbidity, etc) remained unchanged. Thus, according to the discriminative model, the intervention-related factors contributed more to the overall risk of VAP than did patient-related factors, and their reduction was associated with a decrease in VAP prevalence in our neurosurgical ICU.Funding: NoneDisclosures: None

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Risk factors for respiratory Aspergillus fumigatus in German Cystic Fibrosis patients and impact on lung function

Scientific Reports ◽

10.1038/s41598-020-75886-w ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Uta Düesberg ◽

Julia Wosniok ◽

Lutz Naehrlich ◽

Patience Eschenhagen ◽

Carsten Schwarz

Keyword(s):

Risk Factors ◽

Cystic Fibrosis ◽

Lung Function ◽

Aspergillus Fumigatus ◽

Age Groups ◽

Antibiotic Use ◽

Lower Lung ◽

Lung Infections ◽

The Impact

Abstract Airway inflammation and chronic lung infections in cystic fibrosis (CF) patients are mostly caused by bacteria, e.g. Pseudomonas aeruginosa (PA). The role of fungi in the CF lung is still not well elucidated, but evidence for a harmful and complex role is getting stronger. The most common filamentous fungus in CF is Aspergillus fumigatus (AF). Age and continuous antibiotic treatment have been discussed as risk factors for AF colonisation but did not differentiate between transient and persistent AF colonisation. Also, the impact of co-colonisation of PA and AF on lung function is still under investigation. Data from patients with CF registered in the German Cystic Fibrosis Registry database in 2016 and 2017 were retrospectively analysed, involving descriptive and multivariate analysis to assess risk factors for transient or persistent AF colonisation. Age represented an independent risk factor for persistent AF colonisation. Prevalence was low in children less than ten years, highest in the middle age and getting lower in higher age (≥ 50 years). Continuous antibiotic lung treatment was significantly associated with AF prevalence in all age groups. CF patients with chronic PA infection had a lower lung function (FEV1%predicted), which was not influenced by an additional AF colonisation. AF colonisation without chronic PA infection, however, was significantly associated with a lower function, too. Older age up to 49 years and continuous antibiotic use were found to be the main risk factors for AF permanent colonisation. AF might be associated with decrease of lung function if not disguised by chronic PA infection.

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A Systematic Review of Risk Factors Associated with Near-Fatal and Fatal Asthma

Canadian Respiratory Journal ◽

10.1155/2005/837645 ◽

2005 ◽

Vol 12 (5) ◽

pp. 265-270 ◽

Cited By ~ 68

Author(s):

GG Alvarez ◽

M Schulzer ◽

D Jung ◽

JM FitzGerald

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Inhaled Corticosteroids ◽

Respiratory Arrest ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Mortality And Morbidity ◽

Factors Associated ◽

Fatal Asthma ◽

The Impact

BACKGROUND: Asthma mortality and morbidity continue to be a serious global problem. Systematic reviews provide an opportunity to review risk factors in detail.OBJECTIVE: To review all of the literature for risk factors associated with near-fatal asthma (NFA) and fatal asthma (FA).METHODS: A literature search from 1960 to January 2004 in MEDLINE and EMBASE was conducted. Studies were included based on the following criteria: NFA was defined as an asthma exacerbation resulting in respiratory arrest requiring mechanical ventilation or a partial pressure of CO2of at least 45 mmHg or asthma resulting in death (FA); the study reported the number of cases (NFA and/or FA) and asthmatic controls; there was explicit reporting of risk factors; cases that were adult and pediatric in nature; and all study types. Studies that included patients with chronic obstructive pulmonary disease were excluded.RESULTS: Four hundred and three articles were identified, of which 27 met the inclusion criteria. Increased use of medications such as beta-agonists via metered dose inhalers (OR=1.67, 95% CI 0.99 to 2.84, P=0.057) and nebulizers (OR=2.45, 95% CI 1.52 to 3.93, P=0.0002), oral steroids (OR=2.71, 95% CI 1.34 to 5.51, P=0.006) and oral theophylline (OR=2.02, 95% CI 1.03 to 3.98, P=0.04) and a history of hospital (OR=2.62, 95% CI 1.04 to 6.58, P=0.04) and/or intensive care unit (OR=5.14, 95% CI 1.91 to 13.86, P=0.001) admissions and mechanical ventilation (OR=6.69, 95% CI 2.80 to 15.97, P=0.0001) due to asthma were predictors of NFA and FA. Prior emergency department assessment did not confer a greater risk of NFA and FA (OR=1.13, 95% CI 0.43 to 2.92, P=0.810).The use of inhaled corticosteroids (ICS) measured in a dose-independent fashion (did the patient take ICS previously; yes or no) inferred equivocal risk of NFA and FA (OR=1.31, 95% CI 0.83 to 2.05, P=0.25). However, two studies measured the use of ICS in a dose-dependent fashion (ie, measured the number of prescriptions filled within the previous six to 12 months). Both studies showed a trend toward a protective effect against FA. One study showed that the premature cessation of ICS can hasten death.CONCLUSIONS: In the present study, risk factors of NFA and FA have been more accurately defined. Clinicians should identify patients with these characteristics to reduce their risk of NFA and FA. Further research should focus on quantifying the impact of risk factors on asthma deaths.

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Assessment of Risk Factors and Management Associated with Preterm Deliveries and their Outcomes in Tertiary Care Teaching Hospital

Journal of Drug Delivery and Therapeutics ◽

10.22270/jddt.v11i1-s.4556 ◽

2021 ◽

Vol 11 (1-s) ◽

pp. 102-107

Author(s):

T. Lakshmi Susheela ◽

Meda. Venkata Subbiah ◽

M. Ahamadi Tabasum ◽

P. Amreen Khan ◽

M.V. Swetha Kumari ◽

...

Keyword(s):

Risk Factors ◽

Antenatal Care ◽

Tertiary Care ◽

Bed Rest ◽

Perinatal Morbidity ◽

Exclusion Criteria ◽

Neonatal Deaths ◽

Observational Cohort ◽

The Impact ◽

Good Hygiene

Background: Preterm is a major obstetrical challenge of health care. It is the top most cause of perinatal morbidity and mortality of neonatal deaths. The births of these neonates are at a greater risk of developmental disabilities, health and growth problems than neonates of full term. Aim and objective: To assess the risk factors and management associated with preterm deliveries and their outcomes. Materials & Methods: “A prospective observational cohort study” was conducted over a period of 6 months on 80 Preterm subjects, who were enrolled based on inclusion and exclusion criteria. A detailed questionnaire was used to record socio-demographic, clinical profile and prescribing management. Statistical analysis was performed by percentage method using parameters like mean, standard deviation. Results: The impact of incidence range in the present study was 31.52%. Maximum preterm deliveries were observed in the age group of 18-23 years (44%). Multiparous woman was at more risk for preterm i.e., about 51%. The commonest risk factor for preterm was Anemia (45%) followed by Pre-eclampsia (24%). The treatment prescribed for preterm was Betamethasone, Tidilon, Magnesium sulphate, Progesterone. The commonest neonatal outcome was found to be low birth weight with KMC and supplements of vitamins, iron, calcium as a therapy for their better recovery. Conclusion: The study suggests an urgent need for strengthening effective guidelines and appropriate counselling for prevention of preterm. Maintenance of good hygiene, adequate bed rest and proper antenatal care visits for the better outcomes. Keywords: preterm, multiparous, risk factors, neonatal outcomes, antenatal care, cohort.

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Pulmonary Fibrosis after COVID-19 is Associated with Severity of Illness and Blood Leukocyte Telomere Length

10.1101/2021.03.17.21253834 ◽

2021 ◽

Author(s):

Claire F. McGroder ◽

David Zhang ◽

Mohammad A Choudhury ◽

Mary M. Salvatore ◽

Belinda M. D'Souza ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Lactate Dehydrogenase ◽

Lung Function ◽

Telomere Length ◽

Severity Of Illness ◽

Leukocyte Telomere Length ◽

Lung Abnormalities ◽

Independent Risk Factors ◽

Blood Leukocyte

The risk factors for development of fibrotic interstitial lung abnormalities (ILA) after severe COVID-19 are incompletely described and the extent to which CT findings correlate with symptoms and physical function after hospitalization remain unclear. At 4 months after hospitalization, fibrotic ILA was more common in those who underwent mechanical ventilation (72%) than in those who did not (20%). We demonstrate that severity of initial illness, duration of mechanical ventilation, lactate dehydrogenase on admission, and leukocyte telomere length are independent risk factors for fibrotic ILA. These fibrotic changes correlate with lung function, cough and measures of frailty, but not with dyspnea.

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The impact of lung function on cardiovascular diseases and cardiovascular risk factors: a two sample bi-directional Mendelian randomization study

10.1101/2020.06.01.20118919 ◽

2020 ◽

Author(s):

SL Au Yeung ◽

MC Borges ◽

DA Lawlor ◽

CM Schooling

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Lung Function ◽

Mendelian Randomization ◽

Sensitivity Analyses ◽

Summary Statistics ◽

The Impact ◽

Genetic Instruments

AbstractBackgroundObservational studies suggested lung function is inversely associated with cardiovascular disease (CVD) although these studies could be susceptible to residual confounding. We conducted a 2 sample Mendelian randomization study using summary statistics from genome wide association studies (GWAS) to clarify the role of lung function in CVD and its risk factors, and conversely the role of CVD in lung function.MethodsWe obtained genetic instruments for forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) from publicly available UK Biobank summary statistics (n = 421,986). We applied these genetic instruments for FEV1 (260) and FVC (320) to publicly available GWAS summary statistics for coronary artery disease (CAD) (n = 184,305), stroke and its subtypes (n = 446,696), atrial fibrillation (n = 1,030,836), and heart failure (n = 977,320) and cardiovascular risk factors. Inverse variance weighting was used to assess the impact of lung function on these outcomes. Sensitivity analyses included MR-Egger, weighted median, MR-PRESSO, and multivariable Mendelian randomization. We also conducted bi-directional Mendelian randomization to assess whether CVD affects lung function.ResultsFEV1 and FVC were inversely associated with CAD (odds ratio (OR) per standard deviation (SD) increase, 0.72 (95% confidence interval (CI) 0.63 to 0.82) and 0.70 (95%CI 0.62 to 0.78)), overall stroke (0.87 (95%CI 0.77 to 0.97), 0.90 (0.82 to 1.00)), ischemic stroke (0.87 (95%CI 0.77 to 0.99), 0.90 (95%CI 0.80 to 1.00)), small vessel stroke (0.78, (95%CI 0.61 to 1.00), 0.74 (95%CI 0.61 to 0.92)), and large artery stroke (0.69 (95%CI 0.54 to 0.89), 0.72 (95%CI 0.57 to 0.91)). FEV1 and FVC were inversely associated with type 2 diabetes (0.75 (95%CI 0.62 to 0.90), 0.67 (95%CI 0.58 to 0.79)) and systolic blood pressure. Sensitivity analyses produced similar direction for most outcomes although the magnitude sometimes differed. Adjusting for height attenuated results for CAD (e.g. OR for 1SD FEV1 0.95 (0.76 to 1.20), but this may reflect weak instrument bias. This adjustment did not attenuate effects for stroke or type 2 diabetes. No strong evidence was observed for CVD affecting lung function.ConclusionHigher lung function likely protect against CAD and stroke.

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Epidemiology, risk factors and outcomes of bloodstream infection caused by ESKAPEEc pathogens among hospitalized children

BMC Pediatrics ◽

10.1186/s12887-021-02661-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaoshan Peng ◽

Wei Zhou ◽

Yu Zhu ◽

Chaomin Wan

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Bloodstream Infection ◽

Pediatric Population ◽

Significant Risk ◽

University Hospital ◽

Hospitalized Children ◽

Previous Surgery ◽

Significant Difference ◽

The Impact

Abstract Background Bloodstream infection (BSI) resulting from ESKAPEEc pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp) is relevant to high mortality and economic cost. Data concerning the impact of BSI due to ESKAPEEc in pediatric population was virtually scant. Our purpose was to summarize the epidemiology, risk factors and outcomes of ESKAPEEc BSI among hospitalized children. Methods Inpatients diagnosed with BSI with definite etiology between January 2016 and December 2018 were enrolled retrospectively at the West China Second University Hospital. Data were systematically reviewed on patients’ clinical characteristics and laboratory findings to ascertain independent predictors, clinical features and outcomes. Results Of the 228 patients with BSI, 174 (76.3%) were caused by ESKAPEEc (124 MDR-ESKAPEEc). Multivariate analysis demonstrated that premature and/ or low birth weight (odds ratio [OR] = 2.981, P = 0.036), previous surgery and/or trauma (OR = 5.71, P = 0.029) and source of urinary tract infection (OR = 10.60, P = 0.004) were independently associated with ESKAPEEc BSI. The independent risk factor for MRD-ESKAPEEc BSI was nosocomial infection (OR = 3.314, P = 0.037). The overall mortality rate in patients with ESKAPEEc BSI was 14.4% (25/174), and no significant difference was ascertained in mortality between MRD-ESKAPEEc and non-MRD ESKAPEEc BSI groups (13.7% vs. 11.4%, P = 0.692). In addition, previous surgery and/or trauma, thrombocytopenia, and mechanical ventilation were significant risk factors for mortality caused by ESKAPEEc BSI. Conclusions More than two-thirds of BSI among hospitalized children were caused by ESKAPEEc. Previous surgery and/or trauma, thrombocytopenia and mechanical ventilation increased the risk rate for mortality in ESKAPEEc BSI. The risk factors ascertained could assist physicians to early suspect ESKAPEEc BSI and MDR ESKAPEEc BSI.

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Impact of Prematurity on the Buccal Epithelial Cells of the Neonates via Wnt/Beta-Catenin Signaling Pathway and Apoptosis

American Journal of Perinatology ◽

10.1055/s-0041-1740348 ◽

2021 ◽

Author(s):

Hanife Guler Donmez ◽

Hasan Tolga Celik ◽

Gozdem Kayki ◽

Atakan Tanacan ◽

Murat Cagan ◽

...

Keyword(s):

Risk Factors ◽

Signaling Pathway ◽

Obstetric Complications ◽

Preterm Neonates ◽

Beta Catenin ◽

Maternal Risk Factors ◽

Buccal Cells ◽

Maternal Risk ◽

Neonatal Complications ◽

The Impact

Objective Understanding the reflections of prematurity is necessary for the management of neonatal complications. We focused on the impact of prematurity and related “maternal risk factors/obstetric complications” on buccal cells of the neonates via evaluation of the Wnt/β-catenin signaling pathway and apoptosis. Study Design This study consisted of “early preterm neonates (EPN) (≤34th gestational week [gw]) (n = 36),” “late preterm neonates (LPN) (34th– < 37th gw) (n = 46),” and “term neonates (control) (≥37th gw) (n = 56).” Cohort was also subclassified according to the presence of maternal risk factors, obstetric complications, and neonatal complications. Wnt/β-catenin signaling and caspase-3 activation pathways were studied immunocytochemically. Results Wnt/β-catenin signaling positivity was statistically more frequent at buccal smears of the EPN and LPN groups compared with controls (p < 0.001). The cutoff for gestational age at delivery in receiver operating characteristic curve with the best balance of sensitivity (67.4%) and specificity (67.3%) was 35.8th gw for determining the reduction of Wnt/β-catenin signaling positivity (p < 0.001). The study demonstrated that obstetric complications significantly affected the activity of signaling, while maternal risk factors do not have any effect on Wnt/β-catenin signaling pathway (p = 0.003 and p = 0.828, respectively). This study also demonstrated a significant relationship between Wnt/β-catenin signaling pathway and the presence of neonatal complications (p = 0.015). Conclusion Dynamic characteristics of buccal cells are influenced by prematurity and related obstetric and neonatal problems. Buccal smear is a good tool to investigate the impact of prematurity and obstetric problems on perinatal outcome. Key Points

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Risk Factors for Congenital Hearing Loss: Which Are the Most Relevant?

Journal of Interdisciplinary Medicine ◽

10.1515/jim-2017-0023 ◽

2017 ◽

Vol 2 (1) ◽

pp. 58-61

Author(s):

Andor Balázs ◽

Adriana Neagoș

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Hearing Loss ◽

Gestational Age ◽

Low Birthweight ◽

Case Series ◽

Perinatal Period ◽

Hearing Screening ◽

Congenital Hearing Loss ◽

The Impact

AbstractIntroduction:Congenital hearing loss is a multifactorial disease that affects mostly premature newborns exposed to certain risk factors. The recent widespread introduction of newborn hearing screening in Tîrgu Mureş, Romania prompted the need for a multidisciplinary centralized study on the subject.Case series presentation:We collected data from 340 neonates born in 2014 who had undergone neonatal hearing screening with otoacoustic emissions. Our focus group consisted of 137 neonates with a gestational age of less than 37 weeks. We collected data on the pregnancy, birth, and perinatal period, and then analyzed the impact of infections, treatments — with or without ototoxic potential, hypoxia, mechanical ventilation, intrauterine malnutrition, and the presence of malformations. Premature neonates showed a significantly higher number of REFER results than those with a normal gestational age. The rates of low birthweight, head circumference, and infant length; low Apgar scores; hypoxia in the perinatal period; the presence of placental pathology, mechanical ventilation, and perinatal infections; and the concomitant potentially ototoxic treatment were significantly higher in the REFER group. The age of the mother, bilirubin levels, and oxytocin use during birth did not prove to be relevant.Conclusions:Known risk factors can cause hearing loss in a considerable number of newborns and mandate a multidisciplinary approach to the problem at hand. The referral of these patients to an ENT specialist and their correct management according to an individualized hearing recovery plan is crucial

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Hyperbaric hyperoxemia as a risk factor for ventilator-acquired pneumonia?

PLoS ONE ◽

10.1371/journal.pone.0253198 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253198

Author(s):

Morgan Caplan ◽

Thibault Duburcq ◽

Anne-Sophie Moreau ◽

Julien Poissy ◽

Saad Nseir ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Multivariate Analysis ◽

Risk Factor ◽

Radiological Criteria ◽

Clinical Investigations ◽

Independent Risk Factors ◽

Hospital Transport ◽

The Impact ◽

The Relationship

Objectives Ventilator-acquired pneumonia (VAP) is the leading cause of serious associated infections in Intensive Care Units (ICU) and is associated with significant morbidity. The use of hyperbaric oxygen therapy (HBOT) in patients on mechanical ventilation may increase exposure to certain risk factors such as hyperoxemia and the need for multiple transfers. The aim of our study was to assess the relationship between HBOT and VAP. Method This retrospective observational study was performed from March 2017 to March 2018 in a 10-bed ICU using HBOT. All patients receiving mechanical ventilation (MV) for more than 48 hours were eligible. VAP was defined using clinical and radiological criteria. Data collection was carried out via digital medical records. Risk factors for VAP were determined by univariate and multivariate analysis. Results Forty-two (23%) of the 182 patients enrolled developed at least one episode of VAP. One hundred and twenty-four (68%) patients received HBOT. The incidence rate of VAP was 34 per 1000 ventilator days. The occurrence of VAP was significantly associated with immunosuppression (p<0.029), MV duration (5 [3–7] vs 8 [5–11.5] days, p<0.0001), length of stay (8 [5–13] vs 19.5 [13–32] days, p<0.0001), reintubation (p<0.0001), intra-hospital transport (p = 0.001), use of paralytic agents (p = 0.013), tracheotomy (p = 0.003) and prone position (p = 0.003). The use of HBOT was not associated with the occurrence of VAP. Multivariate analysis identified reintubation (OR: 8.3 [2.6–26.6]; p<0.0001), intra-hospital transport (OR: 3.5 [1.3–9.2]; p = 0.011) and the use of paralytic agents (OR: 3.3 [1.3–8.4]; p = 0.014) as independent risk factors for VAP. Conclusion Known risk factors for VAP are to be found within our ICU population. HBOT, however, is not an extra risk factor for VAP within this group. Further experimental and clinical investigations are needed to understand the impact of HBOT on the occurrence of VAP and on physiological microbiome.

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