Alicia J Mangram1, Jacqueline Sohn2, Nicolas Zhou2, Alexzandra K Hollingworth3, Francis R Ali-Osman3, Joseph F Sucher3, Melissa Moyer3, James K Dzandu3. 1. HonorHealth John C. Lincoln Medical Center, Department of Trauma Services, 250 E Dunlap Avenue, Phoenix, AZ, USA. Electronic address: alicia.mangram@jcl.com. 2. Arizona College of Osteopathic Medicine, Department of Surgery and Anesthesia, Midwestern University, Glendale, AZ, USA. 3. HonorHealth John C. Lincoln Medical Center, Department of Trauma Services, 250 E Dunlap Avenue, Phoenix, AZ, USA.
Abstract
BACKGROUND: The high prevalence of ventilator-associated pneumonia (VAP) in trauma patients has been reported in the literature, but the reasons for this observation remain unclear. We hypothesize that trauma factors play critical roles in VAP etiology. METHODS: In this retrospective study, 1,044 ventilated trauma patients were identified from December 2010 to December 2013. Patient-level trauma factors were used to predict pneumonia as study endpoint. RESULTS: Ninety-five of the 1,044 ventilated trauma patients developed pneumonia. Rib fractures, pulmonary contusion, and failed prehospital intubation were significant predictors of pneumonia in a multivariate model. CONCLUSIONS: It is time to redefine VAP in trauma patients based on the effect of rib fractures, pulmonary contusions, and failed prehospital intubations. The Centers for Disease Control and Prevention definition of VAP needs to be modified to reflect the effect of trauma factors in the etiology of trauma-associated pneumonia.
BACKGROUND: The high prevalence of ventilator-associated pneumonia (VAP) in traumapatients has been reported in the literature, but the reasons for this observation remain unclear. We hypothesize that trauma factors play critical roles in VAP etiology. METHODS: In this retrospective study, 1,044 ventilated traumapatients were identified from December 2010 to December 2013. Patient-level trauma factors were used to predict pneumonia as study endpoint. RESULTS: Ninety-five of the 1,044 ventilated traumapatients developed pneumonia. Rib fractures, pulmonary contusion, and failed prehospital intubation were significant predictors of pneumonia in a multivariate model. CONCLUSIONS: It is time to redefine VAP in traumapatients based on the effect of rib fractures, pulmonary contusions, and failed prehospital intubations. The Centers for Disease Control and Prevention definition of VAP needs to be modified to reflect the effect of trauma factors in the etiology of trauma-associated pneumonia.
Authors: Jon D Simmons; Daniel R Freno; C Annie Muscat; Boniface Obiako; Yann-Leei L Lee; Viktor M Pastukh; Sidney B Brevard; Mark N Gillespie Journal: J Trauma Acute Care Surg Date: 2017-01 Impact factor: 3.313
Authors: Lukas L Negrin; Gabriel Halat; Stephan Kettner; Markus Gregori; Robin Ristl; Stefan Hajdu; Thomas Heinz Journal: PLoS One Date: 2017-04-05 Impact factor: 3.240