Duration of prehospital intubation is not a risk factor for development of early ventilator-associated pneumonia

• Published in: Journal of critical care 2014-08, Vol.29 (4), p.539-544
• Main Authors: Mohr, Nicholas M., MD, Harland, Karisa K., PhD, MPH, Skeete, Dionne, MD, Pearson, Kent, MD, Choi, Kent, MD, MS
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Chronic obstructive pulmonary disease; Confidence intervals; Critical Care; Critical Illness; Disease control; Emergency Medical Services; Emergency medicine; Ethanol; Female; Hospitalization; Hospitals; Humans; Incidence; Intensive care; Intubation; Intubation - adverse effects; Logistic Models; Male; Middle Aged; Mortality; Pneumonia ventilator-associated; Pneumonia, Ventilator-Associated - diagnosis; Pneumonia, Ventilator-Associated - epidemiology; Pneumonia, Ventilator-Associated - etiology; Prevention and control; Retrospective Studies; Risk Factors; Sensitivity analysis; Sensitivity and Specificity; Time Factors; Trauma Centers; Ventilation; Ventilators; Wounds and injuries; Wounds and Injuries - therapy
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2014.03.030

Abstract Purpose Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality among critically ill patients with trauma. Few VAP prevention strategies have been studied in the prehospital environment. The objectives of this study are to measure the association between duration of prehospital intubation and intubation location with subsequent incidence of early (within 5 days) VAP. Materials and Methods Single-center retrospective cohort study of all intubated adult (age ≥ 18 years) patients with trauma presenting to a 711-bed Midwestern Level I trauma center between January 2005 and December 2011 (n = 860). Results Thirty-five patients (6.4%) were diagnosed as having early VAP during the study period. Using multivariable logistic regression to adjust for age, injury severity score, and year (corresponding to VAP bundle implementation), the duration of intubation prior to hospital admission was not associated with subsequent diagnosis of VAP (adjusted odds ratio, 0.90 per hour; 95% confidence interval, 0.70-1.15). Location of intubation was similarly not associated with VAP. Conclusions Duration of prehospital intubation and intubation location were not different in patients with trauma who developed early VAP. Further prospective analyses should be conducted to better elucidate the effect of prehospital management on the development of traditionally in-hospital complications.