Open AccessFactors Predictive of Ventilator‐associated Pneumonia in Critically Ill Trauma Patients
Author(s) -
Younan Duraid,
Delozier Sarah J.,
Adamski John,
Loudon Andrew,
Violette Aisha,
Ustin Jeffrey,
Tinkoff Glen,
Moorman Matthew L.,
McQuay Nathaniel
Publication year - 2020
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-019-05286-3
Subject(s) - medicine , intensive care unit , injury severity score , acute kidney injury , mechanical ventilation , pneumonia , incidence (geometry) , trauma center , ventilator associated pneumonia , apache ii , retrospective cohort study , emergency medicine , poison control , injury prevention , physics , optics
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.