Nicholas M Mohr1, Karisa K Harland2, Dionne Skeete3, Kent Pearson4, Kent Choi3. 1. Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: nicholas-mohr@uiowa.edu. 2. Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Injury Prevention Research Center, University of Iowa College of Public Health, Iowa City, IA. 3. Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA. 4. Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine, Iowa City, IA.
Abstract
PURPOSE: Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality among critically ill patients with trauma. Few VAP prevention strategies have been studied in the prehospital environment. The objectives of this study are to measure the association between duration of prehospital intubation and intubation location with subsequent incidence of early (within 5 days) VAP. MATERIALS AND METHODS: Single-center retrospective cohort study of all intubated adult (age≥18 years) patients with trauma presenting to a 711-bed Midwestern Level I trauma center between January 2005 and December 2011 (n=860). RESULTS: Thirty-five patients (6.4%) were diagnosed as having early VAP during the study period. Using multivariable logistic regression to adjust for age, injury severity score, and year (corresponding to VAP bundle implementation), the duration of intubation prior to hospital admission was not associated with subsequent diagnosis of VAP (adjusted odds ratio, 0.90 per hour; 95% confidence interval, 0.70-1.15). Location of intubation was similarly not associated with VAP. CONCLUSIONS: Duration of prehospital intubation and intubation location were not different in patients with trauma who developed early VAP. Further prospective analyses should be conducted to better elucidate the effect of prehospital management on the development of traditionally in-hospital complications.
PURPOSE: Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality among critically illpatients with trauma. Few VAP prevention strategies have been studied in the prehospital environment. The objectives of this study are to measure the association between duration of prehospital intubation and intubation location with subsequent incidence of early (within 5 days) VAP. MATERIALS AND METHODS: Single-center retrospective cohort study of all intubated adult (age≥18 years) patients with trauma presenting to a 711-bed Midwestern Level I trauma center between January 2005 and December 2011 (n=860). RESULTS: Thirty-five patients (6.4%) were diagnosed as having early VAP during the study period. Using multivariable logistic regression to adjust for age, injury severity score, and year (corresponding to VAP bundle implementation), the duration of intubation prior to hospital admission was not associated with subsequent diagnosis of VAP (adjusted odds ratio, 0.90 per hour; 95% confidence interval, 0.70-1.15). Location of intubation was similarly not associated with VAP. CONCLUSIONS: Duration of prehospital intubation and intubation location were not different in patients with trauma who developed early VAP. Further prospective analyses should be conducted to better elucidate the effect of prehospital management on the development of traditionally in-hospital complications.
Authors: S Wutzler; K Sturm; T Lustenberger; H Wyen; K Zacharowksi; I Marzi; T Bingold Journal: Eur J Trauma Emerg Surg Date: 2016-06-06 Impact factor: 3.693
Authors: Terrence Wong; Adam B Schlichting; Andrew J Stoltze; Brian M Fuller; Amanda Peacock; Kari K Harland; Azeemuddin Ahmed; Nicholas Mohr Journal: Am J Crit Care Date: 2016-03 Impact factor: 2.228
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