Analysis of factors related to the development of ventilator-associated pneumonia: use of existing databases

2000 ◽  
Vol 9 (5) ◽  
pp. 344-349 ◽  
Author(s):  
JF Byers ◽  
ML Sole
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Odds Ratio ◽  
Demographic Data ◽  
Tube Feeding ◽  
Causative Organism ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Receptor Antagonists ◽  
Level I

OBJECTIVE: To investigate factors related to ventilator-associated pneumonia to assist in the development and implementation of prevention strategies. METHODS: A retrospective, descriptive design was used. Power analysis determined sample size. A consecutive sample of 120 patients admitted to the critical care units of a level I trauma center who were receiving mechanical ventilation was used. Data were obtained from clinical and financial databases. Variables included demographic data, causative organism of the pneumonia, medications, comorbid conditions, complications, duration of therapies, length of stay, and cost per case. RESULTS: The average patient was a 49-year-old man. The sample was 54.9% trauma patients, and the prevalence of ventilator-associated pneumonia was 16.7%. Significant factors included duration of intubation (r = 0.28, P = .005), mechanical ventilation (r = 0.26, P = .005), and tube feeding (r = 0.30, P = .001); trauma (phi = 0.24, P = .009); and use of histamine2 receptor antagonists (phi = -0.25, P = .006). The only variable that significantly increased the odds ratio for ventilator-associated pneumonia was trauma. The only variable that significantly decreased the odds ratio was use of histamine2 receptor antagonists. Patients in whom ventilator-associated pneumonia developed had a 16-day increase in length of stay (t = -2.68, P = .008), and a $29,369 increase in cost per case (t = -3.649, P = .000). CONCLUSIONS: These findings provide a baseline for discussions about potential changes in practice to help prevent ventilator-associated pneumonia.

Transitioning to Thoracic Endovascular Repair: A Single Institution's Analysis of the Management of Blunt Aortic Injury

2013 ◽  
Vol 79 (8) ◽  
pp. 806-809 ◽  
Author(s):  
Clay G. Nelson ◽  
Richard E. Redlinger ◽  
Jay N. Collins ◽  
Leonard J. Weireter ◽  
L. D. Britt
Keyword(s):  
Length Of Stay ◽  
Endovascular Repair ◽  
Injury Severity ◽  
Demographic Data ◽  
Aortic Injury ◽  
Trauma Patients ◽  
Acute Complications ◽  
Aortic Injuries ◽  
Level I

Over the past 15 years, there has been a rapid transformation in the way blunt aortic injuries (BAIs) are managed shifting from open thoracotomies to thoracic endovascular repairs (TEVAR). As a result of this change, we sought to describe our experience with open and endovascular repairs through a retrospective analysis of all trauma patients admitted with BAI to our Level I trauma center from 2002 to 2011. Demographic data, type of repair, complications, length of stay (LOS) data, and mortality were identified. No difference was noted in age, sex, Injury Severity Score, or Glasgow Coma Scale score between the two groups. There were also no differences in the number of acute complications or mortality. Intensive care unit (ICU) LOS was significantly shorter in the TEVAR group (20 vs 9 days, P < 0.05). Additionally, there was a trend toward shorter hospital LOS (28 vs 18 days, P = 0.07) and ventilator length of stay (12 vs 5 days, P = 0.171). In summary, endovascular repair of BAI is safe and has no increased rate of acute complications or mortality. ICU LOS is much shorter with TEVAR, and there was a trend toward shorter ventilator and hospital LOS, all of which may result in decreased cost. Still, more needs to be learned about potential long-term complications.

scholarly journals Impact of dexamethasone on the incidence of ventilator-associated pneumonia and blood stream infections in COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ines Gragueb-Chatti ◽  
Alexandre Lopez ◽  
Dany Hamidi ◽  
Christophe Guervilly ◽  
Anderson Loundou ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Study ◽  
Length Of Stay ◽  
Critically Ill ◽  
Invasive Mechanical Ventilation ◽  
Blood Stream ◽  
Hospital Length Of Stay ◽  
Ventilator Associated Pneumonia ◽  
Blood Stream Infections ◽  
Second Wave

Abstract Background Dexamethasone decreases mortality in patients with severe coronavirus disease 2019 (COVID-19) and has become the standard of care during the second wave of pandemic. Dexamethasone is an immunosuppressive treatment potentially increasing the risk of secondary hospital acquired infections in critically ill patients. We conducted an observational retrospective study in three French intensive care units (ICUs) comparing the first and second waves of pandemic to investigate the role of dexamethasone in the occurrence of ventilator-associated pneumonia (VAP) and blood stream infections (BSI). Patients admitted from March to November 2020 with a documented COVID-19 and requiring mechanical ventilation (MV) for ≥ 48 h were included. The main study outcomes were the incidence of VAP and BSI according to the use of dexamethasone. Secondary outcomes were the ventilator-free days (VFD) at day-28 and day-60, ICU and hospital length of stay and mortality. Results Among the 151 patients included, 84 received dexamethasone, all but one during the second wave. VAP occurred in 63% of patients treated with dexamethasone (DEXA+) and 57% in those not receiving dexamethasone (DEXA−) (p = 0.43). The cumulative incidence of VAP, considering death, duration of MV and late immunosuppression as competing factors was not different between groups (p = 0.59). A multivariate analysis did not identify dexamethasone as an independent risk factor for VAP occurrence. The occurrence of BSI was not different between groups (29 vs. 30%; p = 0.86). DEXA+ patients had more VFD at day-28 (9 (0–21) vs. 0 (0–11) days; p = 0.009) and a reduced ICU length of stay (20 (11–44) vs. 32 (17–46) days; p = 0.01). Mortality did not differ between groups. Conclusions In this cohort of COVID-19 patients requiring invasive MV, dexamethasone was not associated with an increased incidence of VAP or BSI. Dexamethasone might not explain the high rates of VAP and BSI observed in critically ill COVID-19 patients.

scholarly journals Among Trauma Patients, Younger Men with Ventilator-Associated Pneumonia Have Worse Outcomes Compared to Older Men—An Exploratory Study

Healthcare ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 67
Author(s):  
Duraid Younan ◽  
Sarah Delozier ◽  
Nathaniel McQuay ◽  
John Adamski ◽  
Aisha Violette ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Older Men ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Icu Stay ◽  
Younger Men

Background: Ventilator-associated pneumonia is associated with significant morbidity. Although the association of gender with outcomes in trauma patients has been debated for years, recently, certain authors have demonstrated a difference. We sought to compare the outcomes of younger men and women to older men and women, among critically ill trauma patients with ventilator-associated pneumonia (VAP). Methods: We reviewed our trauma data base for trauma patients with ventilator-associated pneumonia admitted to our trauma intensive care unit between January 2016 and June 2018. Data collected included demographics, injury mechanism and severity (ISS), admission vital signs and laboratory data and outcome measures including hospital length of stay, ICU stay and survival. Patients were also divided into younger (<50) and older (≥50) to account for hormonal status. Linear regression and binary logistic regression models were performed to compare younger men to older men and younger women to older women, and to examine the association between gender and hospital length of stay (LOS), ICU stay (ICUS), and survival. Results: Forty-five trauma patients admitted to our trauma intensive care unit during the study period (January 2016 to August 2018) had ventilator-associated pneumonia. The average age was 58.9 ± 19.6 years with mean ISS of 18.2 ± 9.8. There were 32 (71.1%) men, 27 (60.0%) White, and 41 (91.1%) had blunt trauma. Mean ICU stay was 14.9 ± 11.4 days and mean total hospital length of stay (LOS) was 21.5 ± 14.6 days. Younger men with VAP had longer hospital LOS 28.6 ± 17.1 days compared to older men 16.7 ± 6.6 days, (p < 0.001) and longer intensive care unit stay 21.6 ± 15.6 days compared to older men 11.9 ± 7.3 days (p = 0.02), there was no significant difference in injury severity (ISS was 22.2 ± 8.4 vs. 17 ± 8, p = 0.09). Conclusions: Among trauma patients with VAP, younger men had longer hospital length of stay and a trend towards longer ICU stay. Further research should focus on the mechanisms behind this difference in outcome using a larger database.

Risk Factors for Ventilator-Associated Pneumonia in Infants and Children: a Cross-sectional Cohort Study

2014 ◽  
Vol 23 (6) ◽  
pp. 469-476 ◽  
Author(s):  
Denise Miyuki Kusahara ◽  
Camila da Cruz Enz ◽  
Ariane Ferreira Machado Avelar ◽  
Maria Angélica Sorgini Peterlini ◽  
Mavilde da Luz Gonçalves Pedreira
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Odds Ratio ◽  
Pediatric Intensive Care ◽  
Ventilator Associated Pneumonia ◽  
Vasoactive Drugs ◽  
Cross Sectional

Background The epidemiology of ventilator-associated pneumonia is well described for adults, but little information is available on risk factors for this disease in children. Objective To identify predisposing factors for ventilator-associated pneumonia in children. Methods A cross-sectional prospective cohort study of 96 patients in a 9-bed pediatric intensive care unit was performed. Variables examined were demographic characteristics, inpatient care, medications, nutrition, invasive procedures, and characteristics of mechanical ventilation. Data were analyzed by using Pearson χ2 analysis, Fisher exact and Mann-Whitney tests, odds ratios, and forward stepwise logistic regression. Results Occurrence of ventilator-associated pneumonia correlated positively with use of nasoenteral tubes (odds ratio, 5.278; P &lt; .001), intermittent administration of nutritional formula (odds ratio, 6.632; P = .005), emergency reintubation (odds ratio, 2.700; P = .02), use of vasoactive drugs (odds ratio, 5.108; P = .009), duration of mechanical ventilation (P &lt; .001), and length of stay in the pediatric intensive care unit (P &lt; .001) and in the hospital (P = .01). Conclusion Use of vasoactive drugs, presence of a nasoenteral tube, and duration of stay in the pediatric intensive care unit were independent risk factors for ventilator-associated pneumonia.

The Affordable Care Act and its association with length of stay and payer status for trauma patients at a level I trauma center

2017 ◽  
Vol 213 (5) ◽  
pp. 870-873 ◽  
Author(s):  
Vicente Jose Undurraga Perl ◽  
Chris Dodgion ◽  
Kyle Hart ◽  
Bruce Ham ◽  
Martin Schreiber ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Affordable Care Act ◽  
Trauma Center ◽  
Trauma Patients ◽  
The Affordable Care Act ◽  
Level I

scholarly journals Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis

2020 ◽  
Vol 29 (155) ◽  
pp. 190107 ◽  
Author(s):  
Diana P. Pozuelo-Carrascosa ◽  
Ángel Herráiz-Adillo ◽  
Celia Alvarez-Bueno ◽  
Jose Manuel Añón ◽  
Vicente Martínez-Vizcaíno ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Ventilator Associated Pneumonia ◽  
Effective Measure ◽  
Overview Of Reviews ◽  
Subglottic Secretion ◽  
Subglottic Secretion Drainage

Although several guidelines recommend subglottic secretion drainage as a strategy for prevention of ventilator-associated pneumonia (VAP), its use is not widespread. With the aim to assess the effectiveness of subglottic secretion drainage for preventing VAP and to improve other outcomes such as mortality, duration of mechanical ventilation and length of stay in the intensive care unit (ICU) or hospital, an electronic search of the Cochrane Library, MEDLINE, Web of Science and Embase was undertaken. Nine systematic reviews with meta-analysis (in the overview of reviews) and 20 randomised controlled trials (in the updated meta-analysis) were included.In the overview of reviews, all systematic reviews with meta-analysis included found a positive effect of subglottic secretion drainage in the reduction of incidence of VAP. In the updated meta-analysis, subglottic secretion drainage significantly reduced VAP incidence (risk ratio (RR) 0.56, 95% CI 0.48–0.63; I2=0%, p=0.841) and mortality (RR 0.88, 95% CI 0.80–0.97; I2=0%, p=0.888).This is the first study that has found a decrease of mortality associated with the use of subglottic secretion drainage. In addition, subglottic secretion drainage is an effective measure to reduce VAP incidence, despite not improving the duration of mechanical ventilation and ICU and/or hospital length of stay.

scholarly journals Higher CICU mechanical ventilation volumes are associated with lower in-hospital mortality

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
S Nandiwada ◽  
S Islam ◽  
J Jentzer ◽  
PE Miller ◽  
CB Fordyce ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Invasive Mechanical Ventilation ◽  
High Volume ◽  
Coronary Intervention ◽  
Annual Volume ◽  
Low Volume

Abstract Funding Acknowledgements Type of funding sources: None. Background  The incidence of respiratory failure and the provision of invasive and non-invasive mechanical ventilation (MV) in patients admitted to cardiac intensive care units (CICU) are increasing. While institutional MV volumes are associated with reduced mortality in medical and surgical ICUs, this relationship has not been characterized in the CICU population. Purpose  By describing the relationship between institutional MV volume and outcomes in the CICUs, we hope to shed light on minimum volume benchmarks for providing MV. Methods  National Canadian population-based data from 2005 to 2015 was used to identify patients admitted to CICUs requiring MV. CICUs were categorized into low (≤100), intermediate (101-300), and high (&gt;300) volume centers based on spline knots identified in the association between annual MV volume and mortality (Figure). Outcomes of interests included all-cause in-hospital mortality, the proportion of patients requiring prolonged MV (&gt;96 hours) and CICU length of stay (LOS). Results  Among the 47,173 CICU admissions that required MV, 89.5% (42,200) required invasive mechanical ventilation. The median annual CICU MV volume was 127 (range 1-490). In-hospital mortality was lower in intermediate (29.2%, adjusted odds ratio [aOR] 0.84, 95% CI 0.72-0.97, p = 0.019) and high-volume (18.2%; aOR 0.82, 95% CI 0.66-1.02, p = 0.076) centers, compared to low volume centers (35.9%). The proportion of patients requiring prolonged MV was higher in low-volume (29.2%) compared to high-volume (14.8%, OR 0.70, 95% 0.55-0.89, p = 0.003) centers. Point estimates for mortality and prolonged MV were lower in PCI-capable and academic centers (Table). Significantly (p &lt;0.01) lower CICU LOS was observed only in the subgroup of PCI-capable intermediate- and high-volume hospitals. Conclusions  In a national dataset, we observed that higher CICU MV hospital volumes were associated with lower in-hospital mortality, CICU LOS, and fewer episodes of prolonged MV. Pending further validation, these data suggest minimum MV volume benchmarks for CICUs caring for patients with respiratory failure. Further research is warranted to explore these associations in more detail. Unadjusted volume-outcome relationshipsOutcomesGroup 1 Annual Volume ≤100Group 2 Annual Volume 101-300Group 3 Annual Volume &gt;300Totalp-valueTotal N1770224351512047173In-hospital mortality6357 (35.0%)7122 (29.2%)933 (18.2%)14412 (30.6%)p &lt; 0.0001Median CICU LOS(hours)85796679p &lt; 0.0001Episodes of prolonged MV5161 (29.2%)5608 (23.0%)758 (14.8%)11527 (24.4%)p &lt; 0.0001Abbreviations OR (odds ratio), RD (risk difference), CI (confidence interval), PCI (percutaneous coronary intervention), LOS (length of stay)Abstract Figure. Annual CICU MV volume and mortality

Influence of Ventilator-Associated Pneumonia on Length of Stay for Hospitalized Patient Requiring Mechanical Ventilation: A Nationwide Analysis

CHEST Journal ◽  
2014 ◽  
Vol 146 (4) ◽  
pp. 206A ◽  
Author(s):  
Ronak Soni ◽  
Kathan Mehta ◽  
Tapan Mehta ◽  
Khushboo Sheth ◽  
Zeeshan Mansuri ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Ventilator Associated Pneumonia ◽  
Hospitalized Patient

Palliative Care Consultations in Trauma Patients and Role of Do-Not-Resuscitate Orders: Propensity-Matched Study

2020 ◽  
Vol 37 (12) ◽  
pp. 1068-1075
Author(s):  
Alexander A. Fokin ◽  
Joanna Wycech ◽  
Jeffrey K. Katz ◽  
Alexander Tymchak ◽  
Richard L. Teitzman ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Palliative Care ◽  
Length Of Stay ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Do Not Resuscitate ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Do Not Resuscitate Orders

Objective: To delineate characteristics of trauma patients associated with a palliative care consultation (PCC) and to analyze the role of do-not-resuscitate (DNR) orders and related outcomes. Methods: Retrospective study included 864 patients from 2 level one trauma centers admitted between 2012 and 2019.  Level 1 trauma centers are designated for admission of the most severe injured patients. Palliative care consultation group of 432 patients who received PCC and were compared to matched control (MC) group of 432 patients without PCC. Propensity matching covariates included Injury Severity Score, mechanism of injury, gender, and hospital length of stay (HLOS). Analysis included patient demographics, injury parameters, intensive care unit (ICU) admissions, ICU length of stay (ICULOS), duration of mechanical ventilation, timing of PCC and DNR, and mortality. Palliative care consultation patients were further analyzed based on DNR status: prehospital DNR, in-hospital DNR, and no DNR (NODNR). Results: Palliative care consultation compared to MC patients were older, predominantly Caucasian, with more frequent traumatic brain injury (TBI), ICU admissions, and mechanical ventilation. The average time to PCC was 5.3 days. Do-not-resuscitate orders were significantly more common in PCC compared to MC group (71.5% vs 11.1%, P < .001). Overall mortality was 90.7% in PCC and 6.0% in MC ( P < .001). In patients with DNR, mortality was 94.2% in PCC and 18.8% in MC. In-hospital DNR-PCC compared to NODNR-PCC patients had shorter ICULOS (5.0 vs 7.3 days, P = .04), HLOS (6.2 vs 13.2 days, P = .006), and time to discharge (1.0 vs 6.3 days, P = .04). Conclusions: Advanced age, DNR order, and TBI were associated with a PCC in trauma patients and resulted in significantly higher mortality in PCC than in MC patients. Combination of DNR and PCC was associated with shorter ICULOS, HLOS, and time from PCC to discharge.

Hyperglycemia and Infections in Pediatric Trauma Patients

2008 ◽  
Vol 74 (3) ◽  
pp. 195-198 ◽  
Author(s):  
David W. Tuggle ◽  
M. Ann Kuhn ◽  
Susan K. Jones ◽  
Jennifer J. Garza ◽  
Sean Skinner
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Head Injuries ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Severely Injured ◽  
Exact Test ◽  
Glucose Levels ◽  
Increased Risk ◽  
Level I

Hyperglycemia has been associated with poor outcome in children with head injuries and burns. However, there has not been a correlation noted between hyperglycemia and infections in severely injured children. The trauma registry of a Level I trauma center was queried for injured children <13 years admitted between July 1, 1999 and August 31, 2003. The records of severely injured children [Injury Severity Score (ISS) > 15] were examined for survival, age, weight, ISS, infection, length of stay (LOS), and maximum glucose levels within the first 24 hours of injury (D1G). Statistical analysis was performed using a t test, Fisher's exact test, a Mann-Whitney Rank Sum test, or Kendall's Tau where appropriate. Eight hundred and eighty eight children under 13 years of age were admitted. One hundred and nine had an ISS > 15, and 57 survived to discharge with measured D1G. Patients excluded were those who died in less than 72 hours or had an LOS less than 72 hours. The survivors were divided into high glucose (≥130 mg/dL; n = 48) and normal glucose (<130 mg/dL; n = 9). There was no difference between the groups with respect to age, weight, incidence of head injury, and ISS. An elevated D1G correlated with an increased risk of infection (P = 0.05) and an increased LOS (P = 0.01). These data suggest that severely injured children are often hyperglycemic in the first 24 hours after injury. Hyperglycemia in this study population correlated with an increased incidence of infection and increased length of stay. This suggests that strict control of hyperglycemia in injured children may be beneficial.

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