Abstract
Background
Ventilator acquired pneumonia (VAP) is a frequent and serious complication in ICU. Second episodes of VAP are common in trauma patients and may be related to severity of underlying conditions, treatment or bacterial factors of the first VAP. The aim of this study was to identify risk factors of second VAP episodes in trauma injured patients (defined as the development of a new pulmonary infection during or remotely following the first episode).
Design
This is a single-center, retrospective cohort study of trauma injured patients who underwent a first episode of VAP between January 1, 2013 and December 31, 2020 at Beaujon Hospital.
Results
A total of 533 patients with a first episode of VAP were analyzed, mostly with head and/or thoracic traumatic injury. A second episode of VAP occurred in one hundred sixty-seven patients (31.3%). The main risk factors found was the degree of hypoxemia at the time of the first episode [PaO2/FiO2 ratio 100–200, OR 3.12 (1.77–5.69); < 100, OR 5.80 (2.70–12.8)] and severe traumatic brain injury characterized by an initial GCS ≤ 8 [OR 1.65 (1.01–2.74)].
Conclusion
Depth of hypoxemia during the first VAP episode and severity of the initial brain injury are the main risk factors for VAP second episode in trauma injured patients.
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References
Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in Intensive Care Units. JAMA. 2009;302(21):2323–9.
Ferrer M, Torres A. Epidemiology of ICU-acquired pneumonia. Curr Opin Crit Care. 2018;24(5):325–31.
Leone M, Bouadma L, Bouhemad B, Brissaud O, Dauger S, Gibot S, et al. Hospital-acquired pneumonia in ICU. Anaesth Crit Care Pain Med. 2018;37(1):83–98.
Cavalcanti M, Ferrer M, Ferrer R, Morforte R, Garnacho A, Torres A. Risk and prognostic factors of ventilator-associated pneumonia in trauma patients. Crit Care Med. 2006;34(4):1067–72.
Rangel EL, Butler KL, Johannigman JA, Tsuei BJ, Solomkin JS. Risk factors for relapse of ventilator-associated pneumonia in trauma patients. J Trauma Acute Care Surg. 2009;67(1):91–6.
Combes A, Figliolini C, Trouillet JL, Kassis N, Dombret MC, Wolff M, et al. Factors predicting ventilator-associated pneumonia recurrence. Crit Care Med. 2003;31(4):1102–7.
Combes A, Luyt CE, Fagon JY, Wolff M, Trouillet JL, Chastre J, et al. Early predictors for infection recurrence and death in patients with ventilator-associated pneumonia. Crit Care Med. 2007;35(1):146–54.
Cohan P, Wang C, McArthur DL, Cook SW, Dusick JR, Armin B, et al. Acute secondary adrenal insufficiency after traumatic brain injury: a prospective study*. Crit Care Med. 2005;33(10):2358.
Earley AS, Gracias VH, Haut E, Sicoutris CP, Wiebe DJ, Reilly PM, et al. Anemia management program reduces transfusion volumes, incidence of ventilator-associated pneumonia, and cost in trauma patients. J Trauma. 2006;61(1):1–5 (discussion 5–7).
The ARDS Definition Task Force*. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526–33.
Foucrier A, Leflon-Ghibut V, Decavele M, Hego C, Moyer J-D, Paugam-Burtz C. Analyse de la sensibilité in vitro de l’écologie bactérienne des pneumonies de patients ventilés : étude de cohorte. Congrès SFAR ; 2017.
Siempos II, Vardakas KZ, Kyriakopoulos CE, Ntaidou TK, Falagas ME. Predictors of mortality in adult patients with ventilator-associated pneumonia: a meta-analysis. Shock Augusta Ga. 2010;33(6):590–601.
Lepelletier D, Roquilly A, Demeuredit latte D, Mahe PJ, Loutrel O, Champin P, et al. Retrospective analysis of the risk factors and pathogens associated with early-onset ventilator-associated pneumonia in surgical-ICU head-trauma patients. J Neurosurg Anesthesiol. 2010;22(1):32–7.
Decavèle M, Gault N, Moyer JD, Gennequin M, Allain PA, Foucrier A. Prediction models of methicillin sensitive Staphylococcus aureus ventilator associated pneumonia relapse in trauma and brain injury patients: a retrospective analysis. J Crit Care. 2021;13(66):20–5.
Ceccato A, Dominedò C, Ferrer M, Martin-Loeches I, Barbeta E, Gabarrús A, et al. Prediction of ventilator-associated pneumonia outcomes according to the early microbiological response: a retrospective observational study. Eur Respir J. 2022;59(4):2100620.
Paul M, Zemer-Wassercug N, Talker O, Lishtzinsky Y, Lev B, Samra Z, et al. Are all beta-lactams similarly effective in the treatment of methicillin-sensitive Staphylococcus aureus bacteraemia? Clin Microbiol Infect. 2011;17(10):1581–6.
Braquet P, Alla F, Cornu C, Goehringer F, Piroth L, Chirouze C, et al. Factors associated with 12 week case-fatality in Staphylococcus aureus bacteraemia: a prospective cohort study. Clin Microbiol Infect. 2016;22(11):948.e1-948.e7.
Chastre J, Trouillet JL, Vuagnat A, Joly-Guillou ML, Clavier H, Dombret MC, et al. Nosocomial pneumonia in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 1998;157(4 Pt 1):1165–72.
Chollet-Martin S, Jourdain B, Gibert C, Elbim C, Chastre J, Gougerot-Pocidalo MA. Interactions between neutrophils and cytokines in blood and alveolar spaces during ARDS. Am J Respir Crit Care Med. 1996;154(3 Pt 1):594–601.
Moore FA, Moore EE. Evolving concepts in the pathogenesis of postinjury multiple organ failure. Surg Clin North Am. 1995;75(2):257–77.
van der Poll T, Meijers JCM. Systemic inflammatory response syndrome and compensatory anti-inflammatory response syndrome in sepsis. J Innate Immun. 2010;2(5):379–80.
Monneret G, Lepape A, Voirin N, Bohé J, Venet F, Debard AL, et al. Persisting low monocyte human leukocyte antigen-DR expression predicts mortality in septic shock. Intensive Care Med. 2006;32(8):1175–83.
Bouglé A, Tuffet S, Federici L, Leone M, Monsel A, Dessalle T, et al. Comparison of 8 versus 15 days of antibiotic therapy for Pseudomonas aeruginosa ventilator-associated pneumonia in adults: a randomized, controlled, open-label trial. Intensive Care Med. 2022;48(7):841–9.
Ramsamy Y, Muckart DJJ, Bruce JL, Hardcastle TC, Han KSS, Mlisana KP. Empirical antimicrobial therapy for probable v. directed therapy for possible ventilator-associated pneumonia in critically injured patients. South Afr Med J. 2016;106(2):196–200.
Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J. 2017;50(3):1700582.
Kollef MH, Nováček M, Kivistik Ü, Réa-Neto Á, Shime N, Martin-Loeches I, et al. Ceftolozane-tazobactam versus meropenem for treatment of nosocomial pneumonia (ASPECT-NP): a randomised, controlled, double-blind, phase 3, non-inferiority trial. Lancet Infect Dis. 2019;19(12):1299–311.
Udy AA, Roberts JA, Shorr AF, Boots RJ, Lipman J. Augmented renal clearance in septic and traumatized patients with normal plasma creatinine concentrations: identifying at-risk patients. Crit Care. 2013;17(1):R35.
Roberts JA, Aziz MHA, Lipman J, Mouton JW, Vinks AA, Felton TW, et al. Challenges and potential solutions—individualised antibiotic dosing at the bedside for critically ill patients: a structured review. Lancet Infect Dis. 2014;14(6):498–509.
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Villaamil, A., Han, L., Eloy, P. et al. Risk factors of second ventilator-associated pneumonia in trauma patients: a retrospective cohort study. Eur J Trauma Emerg Surg 49, 1981–1988 (2023). https://doi.org/10.1007/s00068-023-02269-x
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DOI: https://doi.org/10.1007/s00068-023-02269-x