Intensive Care Medicine

, Volume 31, Issue 1, pp 64–70 | Cite as

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

  • Marc Leone
  • Stéphane Delliaux
  • Aurélie Bourgoin
  • Jacques Albanèse
  • Franck Garnier
  • Ioana Boyadjiev
  • Francois Antonini
  • Claude Martin
Original

Abstract

Objective

To determine the independent risk factors for late-onset ventilator-associated pneumonia (VAP) in trauma patients receiving selective digestive decontamination (SDD).

Design

A 4-year, prospective cohort study of trauma patients meeting the following criteria: injury severity score >15, and duration of mechanical ventilation >5 days. Predictors of late-onset VAP occurrence were assessed by logistic regression analysis.

Population

All patients received SDD consisting of polymixin E, gentamicin, and amphotericin B applied in nostrils, mouth, and gut with a 3-day course of parenteral cefazolin. VAP was suspected on clinical and radiological signs, and confirmed by the presence of at least one microorganism at a concentration of at least 104 CFU/ml on the broncho-alveolar lavage.

Measurement

Independent risk factors for late-onset VAP.

Results

A late-onset VAP was diagnosed in 90 (56%) out of 159 patients. Predicting factors for late-onset VAP were: use of non-depolarizing muscle relaxant agents for intubation [3.4 (CI 1.08–10.73)], duration of intubation [1.06 (CI 1.01–1.17)], length of intensive care unit (ICU) stay [1.05 (CI 1.02–1.09)], and prior tracheal colonization [1.03 (CI 1.02–1.21)]. Exposure to prior antimicrobial treatment, except SDD, conferred protection [0.3 (0.12–0.74)].

Conclusion

This study confirms the role of duration of intubation, length of ICU stay, and prior tracheal colonization in the development of late-onset VAP. The results also highlight the importance of the initial management on the development of late-onset VAP. The type of neuromuscular blocking agents to intubate trauma patients should be evaluated in future studies.

Keywords

Pneumonia Intensive care unit Trauma Risk factors Logistic regression Decontamination 

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Marc Leone
    • 1
  • Stéphane Delliaux
    • 1
  • Aurélie Bourgoin
    • 1
  • Jacques Albanèse
    • 1
  • Franck Garnier
    • 1
  • Ioana Boyadjiev
    • 1
  • Francois Antonini
    • 1
  • Claude Martin
    • 1
  1. 1.Département d’Anesthésie et de RéanimationCHU NordMarseilleFrance

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