Factors associated with pneumonia in post–cardiac arrest patients receiving therapeutic hypothermia

• Published in: The American journal of emergency medicine 2014-02, Vol.32 (2), p.150-155
• Main Authors: Woo, Jae-Hyug, MD, Lim, Yong Su, MD, PhD, Yang, Hyuk Jun, MD, PhD, Park, Won Bin, MD, Cho, Jin Seong, MD, PhD, Kim, Jin Joo, MD, PhD, Hyun, Sung Youl, MD, PhD, Lee, Gun, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia; Body temperature; Cardiac arrest; Cardiopulmonary resuscitation; Catheters; Coma; Cooling; CPR; Emergency; Emergency medical care; Enteral nutrition; Female; Heart attacks; Humans; Hypothermia; Hypothermia, Induced - adverse effects; Infections; Intensive care; Male; Medical instruments; Middle Aged; Multivariate analysis; Ostomy; Out-of-Hospital Cardiac Arrest - complications; Out-of-Hospital Cardiac Arrest - therapy; Pneumonia; Pneumonia, Bacterial - etiology; Pneumonia, Bacterial - microbiology; Population; Risk Factors; Time Factors; Trauma; Traumatic brain injury; Treatment Outcome
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2013.10.035

Abstract Aim The aim of this study is to investigate risk factors associated with the development of pneumonia during the first 7 days of admission in survivors of cardiac arrest receiving therapeutic hypothermia. Methods A total of 123 patients receiving therapeutic hypothermia after out-of-hospital cardiac arrest between January 2008 and December 2010 were enrolled. Study populations were categorized as “pneumonia present” [P (+)] and “pneumonia absent” [P (−)] contingent upon the development of pneumonia during the first 7 days of admission. Risk factors and outcomes related to development of pneumonia were determined. Results Fifty-nine patients (48.0 %) developed pneumonia, and P (+) patients had lower Acute Physiology and Chronic Health Evaluation II score (22 vs 26); longer durations of central venous catheter (8.9 vs 5.1 days), nasogastric tube (11.1 vs 3.8 days), mechanical ventilation (MV) (9.3 vs 3.7 days), and intensive care unit stay (10.0 vs 5.0 days); and higher rates of nasogastric feeding (66.1% vs 35.9 %), tracheostomy (52.5% vs 17.2 %), and postanoxic seizure (62.7% vs 39.1 %). In multivariate analyses, the occurrence of postanoxic seizure (odds ratio, 2.75; 95% confidence interval, 1.06-7.14; P = .04) and the length of MV (odds ratio, 1.33; 95% confidence interval, 1.15-1.52; P < .001) were independently associated with the development of pneumonia. The development of pneumonia had no significant association with survival (log-rank test, P = .15). Conclusion Postanoxic seizure and prolonged duration of MV are independently associated with development of pneumonia. It may be helpful that we give more attention to the development of pneumonia in patients with postanoxic seizure and provide prompt diagnosis and treatment of postanoxic seizure.