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

Background: Ventilator associated pneumonia (VAP) is a common hospital-acquired infection found in intubated trauma patients. In previous adult studies, VAP has been associated with an increase in length of stay, cost, morbidity, mortality, and longer mechanical ventilation. There remains little examination of the risk factors, prognosis, and microbiology of VAP within the pediatric trauma population. This study aims to analyze factors associated with VAP in pediatric trauma patients. Methods: The Riley Hospital for Children Trauma Registry was utilized to identify intubated pediatric trauma patients from 2016-2020. Patients were excluded if intubated for less than 48 hours. VAP was defined as positive if patients met either Centers for Disease Control definition and or were clinically diagnosed with and treated for VAP. Univariate and multivariate modeling was performed. Results: A total of 171 patients met inclusion criteria and 43 (25%) were diagnosed with VAP. The median age was 8 years (2-13) and ISS was 26.5 (22-35). The median duration of intubation was 203.8 hours (117.3-331.3). The overall mortality was 55 (32.2%). While variables such as lower age and use of MTP resulted in a higher likelihood of mortality, VAP diagnosis was not associated with increased mortality. BAL analysis displayed that the most common cultured bacteria were H. influenzae, Staph. aureus, and Strep. Pneumoniae with most VAPs being diagnosed on day 2 of admission. When analyzing the impact of age, ISS, intubation hours, ICU days, and GI prophylaxis on VAP, only age was significantly associated with VAP: for each year the odds of VAP rose by 10%. Conclusions: A quarter of the pediatric trauma patients were diagnosed with VAP during the study period. No modifiable risk factors were found for VAP with only patient age demonstrating significance for the diagnosis. Further investigation into VAP definition and prevention in pediatric trauma patients should occur given it’s prevalence.

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VENTILATOR ASSOCIATED PNEUMONIA IN TRAUMA PATIENTS; ASSOCIATED RISK FACTORS, MICROBIAL ETIOLOGY AND OUTCOME

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i4.6278 ◽

2021 ◽

Vol 71 (4) ◽

pp. 1476-80

Author(s):

Sohaima Manzoor ◽

Farzana Batool ◽

Muneeba Ahsan Sayeed ◽

Azizullah Khan Dhiloo ◽

Humera Muhammad Ismail ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Emergency Room ◽

Therapeutic Option ◽

Significant Risk ◽

Control Measures ◽

P Value ◽

Trauma Patients ◽

Ventilator Associated Pneumonia

Objective: To assess the incidence, risk factors and outcome of ventilator associated pneumonia in trauma patients. Study Design: Prospective observational study. Place and Duration of Study: Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, from Jul to Dec 2019. Methodology: All trauma patients, above 12 years, placed on mechanical ventilation in the emergency room or intensive care unit, were enrolled. Patients that developed a clinical pulmonary infection score of less than 6 were diagnosed with ventilator associated pneumonia. Results: A total of 113 patients were enrolled in this study. Mean age was 32.9 ± 14.4 years. Thirty eight (33.6%) developed ventilator associated pneumonia. Patients with ventilator associated pneumonia, compared to non-ventilator associated pneumonia, had a longer emergency room stay of 7.8 ± 10.1 vs. 4.7 ± 7.4 days (p-value=0.013), greater ventilator days of 18.5 ± 12.6 vs. 7.9 ± 5.5 (p-value=0.001), longer hospital stay of >14 days in 65.8% vs. 33.3% (p-value=0.001) and higher mortality of 65.8% vs. 56% (p-value=0.213). Nurse to patient ratio and infection control measures for prevention of ventilator associated pneumonia were significantly reduced in emergency room compared to intensive care unit (p-value=0.001). Out of 43 respiratory isolates in 38 ventilator associated pneumonia patients, 40 (93%) were gram negatives of which 23 (57.5%) were multidrug resistant with polymyxins as the only therapeutic option. Conclusion: There was a high incidence of ventilator associated pneumonia in patients with trauma. Prolonged retention in the emergency room is a significant risk factor for ventilator associated pneumonia, due to understaffing..................

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Risk factors for late-onset ventilator-associated pneumonia in trauma patients receiving selective digestive decontamination

Intensive Care Medicine ◽

10.1007/s00134-004-2514-z ◽

2004 ◽

Vol 31 (1) ◽

pp. 64-70 ◽

Cited By ~ 23

Author(s):

Marc Leone ◽

Stéphane Delliaux ◽

Aurélie Bourgoin ◽

Jacques Albanèse ◽

Franck Garnier ◽

...

Keyword(s):

Risk Factors ◽

Late Onset ◽

Selective Digestive Decontamination ◽

Trauma Patients ◽

Ventilator Associated Pneumonia

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Risk factors of ventilator associated pneumonia in trauma patients treated with selective digestive decontamination

European Journal of Anaesthesiology ◽

10.1097/00003643-200406002-00578 ◽

2004 ◽

Vol 21 (Supplement 32) ◽

pp. 160

Author(s):

J. Albanese ◽

M. Leone ◽

F. Antonini ◽

S. Rousseau ◽

I. Boyadjiev ◽

...

Keyword(s):

Risk Factors ◽

Selective Digestive Decontamination ◽

Trauma Patients ◽

Ventilator Associated Pneumonia

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Risk Factors for Relapse of Ventilator-Associated Pneumonia in Trauma Patients

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e3181a8b2b2 ◽

2009 ◽

Vol 67 (1) ◽

pp. 91-96 ◽

Cited By ~ 15

Author(s):

Erika L. Rangel ◽

Karyn L. Butler ◽

Jay A. Johannigman ◽

Betty J. Tsuei ◽

Joseph S. Solomkin

Keyword(s):

Risk Factors ◽

Trauma Patients ◽

Ventilator Associated Pneumonia

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Risk factors for ventilator-associated pneumonia in trauma patients with torso injury: a retrospective single-center study

Journal of International Medical Research ◽

10.1177/03000605211061029 ◽

2021 ◽

Vol 49 (12) ◽

pp. 030006052110610

Author(s):

Jin Young Lee ◽

Young Hoon Sul ◽

Se Heon Kim ◽

Jin Bong Ye ◽

Jin Suk Lee ◽

...

Keyword(s):

Risk Factors ◽

Injury Severity Score ◽

Nasogastric Tube ◽

Severity Score ◽

Injury Severity ◽

Multivariable Logistic Regression Analysis ◽

Trauma Patients ◽

Ventilator Associated Pneumonia ◽

Highly Correlated ◽

Stage Renal Disease

Objective We aimed to identify the risk factors for ventilator-associated pneumonia in patients admitted to critical care after a torso injury. Methods We retrospectively evaluated 178 patients with torso injury aged >15 years who were intubated in the emergency room and placed on a mechanical ventilator after intensive care unit (ICU) admission, survived for >48 hours, had thoracic and/or abdominal injuries, and had no end-stage renal disease. We compared clinico-laboratory variables between ventilator-associated pneumonia (n = 54, 30.3%) and non-ventilator-associated pneumonia (n = 124, 69.7%) groups. Risk factors for ventilator-associated pneumonia were assessed using multivariable logistic regression analysis. Results Ventilator-associated pneumonia was associated with a significantly longer stay in the ICU (11.3 vs. 6.8 days) and longer duration of mechanical ventilation (7 vs. 3 days). Injury Severity Score (adjusted odds ratio [AOR]: 1.048; 95% confidence interval [CI]: 1.008–1.090), use of vasopressors (AOR: 2.541; 95% CI: 1.121–5.758), and insertion of a nasogastric tube (AOR: 6.749; 95% CI: 2.397–18.999) were identified as independent risk factors of ventilator-associated pneumonia. Conclusion Ventilator-associated pneumonia in patients with torso injury who were admitted to the ICU was highly correlated with Injury Severity Score, use of vasopressors, and insertion of a nasogastric tube.

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