Advertisement

Factors Predictive of Ventilator-associated Pneumonia in Critically Ill Trauma Patients

  • Duraid YounanEmail author
  • Sarah J. Delozier
  • John Adamski
  • Andrew Loudon
  • Aisha Violette
  • Jeffrey Ustin
  • Glen Tinkoff
  • Matthew L. Moorman
  • Nathaniel McQuay
  • UHRISES Research Consortium
Original Scientific Report
  • 40 Downloads

Abstract

Background

Ventilator-associated pneumonia (VAP) is a serious complication of mechanical ventilation. We sought to investigate factors associated with the development of VAP in critically ill trauma patients.

Methods

We conducted a retrospective review of trauma patients admitted to our trauma intensive care unit between 2016 and 2018. Patients with ventilator-associated pneumonia were identified from the trauma database. Data collected from the trauma database included demographics (age, gender and race), mechanism of injury (blunt, penetrating), injury severity (injury severity score “ISS”), the presence of VAP, transfused blood products and presenting vital signs.

Results

A total of 1403 patients were admitted to the trauma intensive care unit (TICU) during the study period; of these, 45 had ventilator-associated pneumonia. Patients with VAP were older (p = 0.030), and they had a higher incidence of massive transfusion (p = 0.015) and received more packed cells in the first 24 h of admission (p = 0.028). They had a higher incidence of face injury (p = 0.001), injury to sternum (p = 0.011) and injury to spine (p = 0.024). Patients with VAP also had a higher incidence of acute kidney injury (AKI) (p < 0.001) and had a longer ICU (p < 0.001) and hospital length of stay (p < 0.001). Multiple logistic regression models controlling for age and injury severity (ISS) showed massive transfusion (p = 0.017), AKI (p < 0.001), injury to face (p < 0.001), injury to sternum (p = 0.007), injury to spine (p = 0.047) and ICU length of stay (p < 0.001) to be independent predictors of VAP.

Conclusions

Among critically ill trauma patients, acute kidney injury, injury to the spine, face or sternum, massive transfusion and intensive care unit length of stay were associated with VAP.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict interests.

Informed consent

Informed consent was waived by the institution review board.

References

  1. 1.
    Cohen MJ et al (2009) Protein C depletion early after trauma increases the risk of ventilator-associated pneumonia. J Trauma 67(6):1176–1181CrossRefGoogle Scholar
  2. 2.
    Melsen WG et al (2013) Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis 13(8):665–671CrossRefGoogle Scholar
  3. 3.
    Klompas M (2010) Prevention of ventilator-associated pneumonia. Expert Rev Anti Infect Ther 8(7):791–800CrossRefGoogle Scholar
  4. 4.
    Burger CD, Resar RK (2006) "Ventilator bundle" approach to prevention of ventilator-associated pneumonia. Mayo Clin Proc 81(6):849–850CrossRefGoogle Scholar
  5. 5.
    Youngquist P et al (2007) Implementing a ventilator bundle in a community hospital. Jt Comm J Qual Patient Saf 33(4):219–225CrossRefGoogle Scholar
  6. 6.
    Cook DJ et al (1998) Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 129(6):433–440CrossRefGoogle Scholar
  7. 7.
    Magnotti LJ, Croce MA, Fabian TC (2004) Is ventilator-associated pneumonia in trauma patients an epiphenomenon or a cause of death? Surg Infect (Larchmt) 5(3):237–242CrossRefGoogle Scholar
  8. 8.
    Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165(7):867–903CrossRefGoogle Scholar
  9. 9.
    Hayashi Y et al (2013) Toward improved surveillance: the impact of ventilator-associated complications on length of stay and antibiotic use in patients in intensive care units. Clin Infect Dis 56(4):471–477CrossRefGoogle Scholar
  10. 10.
    Muscedere J et al (2013) The clinical impact and preventability of ventilator-associated conditions in critically ill patients who are mechanically ventilated. Chest 144(5):1453–1460CrossRefGoogle Scholar
  11. 11.
    Rogers AD, Argent AC, Rode H (2012) Review article: ventilator-associated pneumonia in major burns. Ann Burns Fire Disasters 25(3):135–139PubMedPubMedCentralGoogle Scholar
  12. 12.
    Hyde GA et al (2015) Early tracheostomy in trauma patients saves time and money. Injury 46(1):110–114CrossRefGoogle Scholar
  13. 13.
    Cavalcanti M et al (2006) Risk and prognostic factors of ventilator-associated pneumonia in trauma patients. Crit Care Med 34(4):1067–1072CrossRefGoogle Scholar
  14. 14.
    Alvarez-Lerma F et al (2018) Prevention of ventilator-associated pneumonia: the multimodal approach of the Spanish ICU "pneumonia zero" program. Crit Care Med 46(2):181–188CrossRefGoogle Scholar
  15. 15.
    Talbot TR et al (2015) Sustained reduction of ventilator-associated pneumonia rates using real-time course correction with a ventilator bundle compliance dashboard. Infect Control Hosp Epidemiol 36(11):1261–1267CrossRefGoogle Scholar
  16. 16.
    Mehta A, Bhagat R (2016) Preventing ventilator-associated infections. Clin Chest Med 37(4):683–692CrossRefGoogle Scholar
  17. 17.
    Cook A, Norwood S, Berne J (2010) Ventilator-associated pneumonia is more common and of less consequence in trauma patients compared with other critically ill patients. J Trauma 69(5):1083–1091CrossRefGoogle Scholar
  18. 18.
    Younan D et al (2016) Early trauma-induced coagulopathy is associated with increased ventilator-associated pneumonia in spinal cord injury patients. Shock 45(5):502–505CrossRefGoogle Scholar
  19. 19.
  20. 20.
    Arumugam SK et al (2018) Risk factors for ventilator-associated pneumonia in trauma patients: a descriptive analysis. World J Emerg Med 9(3):203–210CrossRefGoogle Scholar
  21. 21.
    Loftus TJ et al (2017) Early bronchoalveolar lavage for intubated trauma patients with TBI or chest trauma. J Crit Care 39:78–82CrossRefGoogle Scholar
  22. 22.
    Aarabi B et al (2012) Predictors of pulmonary complications in blunt traumatic spinal cord injury. J Neurosurg Spine 17(1 Suppl):38–45CrossRefGoogle Scholar
  23. 23.
    Flanagan CD et al (2018) Early tracheostomy in patients with traumatic cervical spinal cord injury appears safe and may improve outcomes. Spine 43(16):1110–1116CrossRefGoogle Scholar
  24. 24.
    Gursel G, Demir N (2006) Incidence and risk factors for the development of acute renal failure in patients with ventilator-associated pneumonia. Nephrology 11(3):159–164CrossRefGoogle Scholar
  25. 25.
    Vaewpanich J et al (2019) Fluid overload and kidney injury score as a predictor for ventilator-associated events. Front Pediatr 7:204CrossRefGoogle Scholar
  26. 26.
    Tsakiridou E et al (2018) Pre-intensive care unit intubation and subsequent delayed intensive care unit admission is independently associated with increased occurrence of ventilator-associated pneumonia. Clin Respir J 12(10):2497–2504CrossRefGoogle Scholar
  27. 27.
    Torrance HD et al (2015) Association between gene expression biomarkers of immunosuppression and blood transfusion in severely injured polytrauma patients. Ann Surg 261(4):751–759CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Duraid Younan
    • 1
    Email author
  • Sarah J. Delozier
    • 2
  • John Adamski
    • 1
  • Andrew Loudon
    • 1
  • Aisha Violette
    • 1
  • Jeffrey Ustin
    • 1
  • Glen Tinkoff
    • 1
  • Matthew L. Moorman
    • 1
  • Nathaniel McQuay
    • 1
  • UHRISES Research Consortium
    • 3
  1. 1.Division of Trauma, Critical Care and Acute Care Surgery, Department of SurgeryUniversity Hospitals ClevelandClevelandUSA
  2. 2.Center for Clinical ResearchUniversity Hospitals ClevelandClevelandUSA
  3. 3.Department of Surgery, University Hospitals Research in Surgical Outcomes and Effectiveness CenterUniversity Hospitals ClevelandClevelandUSA

Personalised recommendations