Risk factors for late-onset ventilator-associated pneumonia in trauma patients receiving selective digestive decontamination
- 110 Downloads
To determine the independent risk factors for late-onset ventilator-associated pneumonia (VAP) in trauma patients receiving selective digestive decontamination (SDD).
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.
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.
Independent risk factors for late-onset VAP.
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)].
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.
KeywordsPneumonia Intensive care unit Trauma Risk factors Logistic regression Decontamination
- 1.Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, Wolff M, Spencer RC, Hemmer M (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 274:639–644CrossRefPubMedGoogle Scholar
- 12.Ewig S, Torres A, El-Ebiary M, Fabregas N, Hernandez C, Gonzalez J, Nicolas JM, Soto L (1999) Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury. Incidence, risk factors, and association with ventilator-associated pneumonia. Am J Respir Crit Care Med 159:188–198PubMedGoogle Scholar
- 16.Akça O, Koltka K, Uzel S, Cakar N, Pembeci K, Sayan MA, Tutuncu AS, Karakas SE, Calangu S, Ozkan T, Esen F, Telci L, Sessler DI, Akpir K (2000) Risk factors for early-onset, ventilator-associated pneumonia in critical care patients: Selected multiresistant versus non resistant bacteria. Anesthesiology 93:638–645PubMedGoogle Scholar
- 18.Albanèse J, Leone M, Martin C (2001) Severe head injury in patients with multiple trauma. In: Vincent JL (ed), Yearbook of intensive care and emergency medicine. Springer, Berlin Heidelberg New York, p 353–376Google Scholar
- 19.Stoutenbeek CP, van Saene HK, Miranda DR, Miranda DR, Zandstra DF (1984) The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intensive Care Med 185–192Google Scholar
- 23.Albanèse J, Leone M, Bourgoin A, Garnier F, Rousseau S, Boyadjev I, Martin C (2004) Risk factors of ventilator-associated pneumonia in trauma patients treated with selective digestive decontamination. Eur J Anaesth 160:A651Google Scholar
- 24.Shapiro BA, Warren J, Egol AB, Greenbaum DM, Jacobi J, Nasraway SA, Schein RM, Spevetz A, Stone JR (1995) Practice parameters for sustained neuromuscular blockade in the adult critically ill patient: an executive summary. Society of Critical Care Medicine. Crit Care Med 23:1601–1605CrossRefPubMedGoogle Scholar
- 32.Krueger WA, Lenhart FP, Neeser G, Ruckdeschel G, Schreckhase H, Eissner HJ, Forst H, Eckart J, Peter K, Unertl KE (2002) Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients: a prospective, stratified, randomized, double-blind, placebo-controlled clinical trial. Am J Respir Crit Care Med 166:1029–1037CrossRefPubMedGoogle Scholar
- 34.Bergmans DC, Bonten MJ, Gaillard CA, Paling JC, van der Geest S, van Tiel FH, Beysens AJ, de Leeuw PW, Stobberingh EE (2001) Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, double-blind, placebo-controlled study. Am J Respir Crit Care Med 164:382–388PubMedGoogle Scholar
- 38.Orozco-Levi M, Torres A, Ferrer M, Piera C, el-Ebiary M, de la Bellacasa JP, Rodriguez-Roisin R (1996) Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am J Respir Crit Care Med 152:1387–1390Google Scholar