BACKGROUND: We reported similar rates of ventilator-associated pneumonia (VAP) previously in trauma patients intubated either in a pre-hospital (PH) venue or the emergency department. A subset of PH intubations with continuous quality assessment was re-examined to identify the intubation factors associated with VAP. METHODS: The subgroup was derived from an existing data set of consecutive adult trauma patients intubated prior to Level I trauma center admission July 2007-July 2008. Intubation details recorded included bag-valve mask ventilation (BVM) and the presence of material in the airway. The diagnosis of VAP was made preferentially by quantitative bronchoalveolar lavage (BAL) cultures (≥ 10⁴ colony-forming units indicating infection). Baseline data, injury characteristics, and circumstances of intubation of patients with and without VAP were compared by univariable analysis. RESULTS: Detailed data were available for 197 patients; 32 (16.2%) developed VAP, on average 6.0±0.7 days after admission. Baseline characteristics were similar in the groups, but diabetes mellitus was more common in the VAP group (4 [12.5%] vs. 5 [3.0%]; p=0.02). There was a higher rate of blunt injury in the VAP patients (28 [87.5%] vs. 106 [64.2%]; p=0.01) and higher injury severity scores (33.1±2.8 vs. 23.0±1.0; p=0.0002) and chest Abbreviated Injury Scores (2.6±0.3 vs. 1.5±0.1; p=0.002). Lower Glasgow Coma Scale scores (7.9±0.9 vs. 9.9±0.4; p=0.04) and greater use of BVM (18 [56.3%] vs. 56 [34.0%]; p=0.02) were observed in patients who developed VAP. Among aspirations, 10 (31.3%) of patients with emesis developed VAP compared with only 4 (12.5%) with blood in the airway (p=0.003). CONCLUSION: Aspiration, along with depressed consciousness and greater injury severity, may predispose trauma patients to VAP. Prospective studies should focus on the quality and timing of aspiration relative to intubation to determine if novel interventions can prevent aspiration or decrease the risk of VAP after aspiration.
BACKGROUND: We reported similar rates of ventilator-associated pneumonia (VAP) previously in traumapatients intubated either in a pre-hospital (PH) venue or the emergency department. A subset of PH intubations with continuous quality assessment was re-examined to identify the intubation factors associated with VAP. METHODS: The subgroup was derived from an existing data set of consecutive adult traumapatients intubated prior to Level I trauma center admission July 2007-July 2008. Intubation details recorded included bag-valve mask ventilation (BVM) and the presence of material in the airway. The diagnosis of VAP was made preferentially by quantitative bronchoalveolar lavage (BAL) cultures (≥ 10⁴ colony-forming units indicating infection). Baseline data, injury characteristics, and circumstances of intubation of patients with and without VAP were compared by univariable analysis. RESULTS: Detailed data were available for 197 patients; 32 (16.2%) developed VAP, on average 6.0±0.7 days after admission. Baseline characteristics were similar in the groups, but diabetes mellitus was more common in the VAP group (4 [12.5%] vs. 5 [3.0%]; p=0.02). There was a higher rate of blunt injury in the VAPpatients (28 [87.5%] vs. 106 [64.2%]; p=0.01) and higher injury severity scores (33.1±2.8 vs. 23.0±1.0; p=0.0002) and chest Abbreviated Injury Scores (2.6±0.3 vs. 1.5±0.1; p=0.002). Lower Glasgow Coma Scale scores (7.9±0.9 vs. 9.9±0.4; p=0.04) and greater use of BVM (18 [56.3%] vs. 56 [34.0%]; p=0.02) were observed in patients who developed VAP. Among aspirations, 10 (31.3%) of patients with emesis developed VAP compared with only 4 (12.5%) with blood in the airway (p=0.003). CONCLUSION: Aspiration, along with depressed consciousness and greater injury severity, may predispose traumapatients to VAP. Prospective studies should focus on the quality and timing of aspiration relative to intubation to determine if novel interventions can prevent aspiration or decrease the risk of VAP after aspiration.
Authors: Heather L Evans; David H Zonies; Keir J Warner; Eileen M Bulger; Sam R Sharar; Ronald V Maier; Joseph Cuschieri Journal: Arch Surg Date: 2010-11
Authors: Keir J Warner; David Carlbom; Colin R Cooke; Eileen M Bulger; Michael K Copass; Sam R Sharar Journal: Prehosp Emerg Care Date: 2010 Jan-Mar Impact factor: 3.077
Authors: Addison K May; Jacob S Brady; Joann Romano-Keeler; Wonder P Drake; Patrick R Norris; Judith M Jenkins; Richard J Isaacs; Erik M Boczko Journal: Chest Date: 2015-06 Impact factor: 9.410
Authors: Christopher H Pham; Mike Fang; Sebastian Q Vrouwe; Catherine M Kuza; Haig A Yenikomshian; Justin Gillenwater Journal: J Burn Care Res Date: 2020-07-03 Impact factor: 1.845
Authors: Vladislav A Dolgachev; Bi Yu; Julia M Reinke; Krishnan Raghavendran; Mark R Hemmila Journal: J Trauma Acute Care Surg Date: 2012-03 Impact factor: 3.313
Authors: Martin Gothner; Dirk Buchwald; Justus T Strauch; Thomas A Schildhauer; Justyna Swol Journal: Scand J Trauma Resusc Emerg Med Date: 2015-03-28 Impact factor: 2.953
Authors: Ana Catalina Hernandez Padilla; Timothée Trampont; Thomas Lafon; Thomas Daix; Dominique Cailloce; Olivier Barraud; François Dalmay; Philippe Vignon; Bruno François Journal: PLoS One Date: 2019-05-23 Impact factor: 3.240