Back to Search
Start Over
Timing of Intubation and Ventilator-Associated Pneumonia Following Injury
- Source :
- Archives of Surgery. 145:1041
- Publication Year :
- 2010
- Publisher :
- American Medical Association (AMA), 2010.
-
Abstract
- In an emergency medical system with established rapid-sequence intubation protocols, prehospital (PH) intubation of patients with trauma is not associated with a higher rate of ventilator-associated pneumonia (VAP) than emergency department (ED) intubation.Retrospective observational cohort.Level I trauma center.Adult patients with trauma intubated in a PH or an ED setting from July 1, 2007, through July 31, 2008.Diagnosis of VAP by means of bronchoscopic alveolar lavage or clinical assessment when bronchoscopic alveolar lavage was impossible. Secondary outcomes included time to VAP, length of hospitalization, and in-hospital mortality.Of 572 patients, 412 (72.0%) underwent PH intubation. The ED group was older than the PH group (mean ages, 46.4 vs 39.1 years; P.001) and had a higher incidence of blunt injury (142 [88.8%] vs 322 [78.2%]; P = .002). The mean (SD) lowest recorded ED systolic blood pressure was lower in the ED group (102.8 [1.9] vs 111.4 [1.2] mm Hg; P.001), despite similar mean injury severity scores in both groups (27.2 [0.7] vs 27.0 [1.1]; P = .94). There was no difference in the mean rate of VAP (30 [18.8%] vs 71 [17.2%]; P = .66) or mean time to diagnosis (8.1 [1.2] vs 7.8 [1.0] days; P = .89). Logistic regression analysis identified history of drug abuse, lowest recorded ED systolic blood pressure, and injury severity score as 3 independent factors predictive of VAP.Prehospital intubation of patients with trauma is not associated with higher risk of VAP. Further investigation of intubation factors and the incidence and timing of aspiration is required to identify potentially modifiable factors to prevent VAP.
- Subjects :
- Adult
Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Comorbidity
Bronchoalveolar Lavage
Injury Severity Score
Trauma Centers
Risk Factors
Bronchoscopy
Intubation, Intratracheal
Humans
Medicine
Intubation
Glasgow Coma Scale
Hospital Mortality
Emergency Treatment
Retrospective Studies
Cross Infection
Chi-Square Distribution
business.industry
Trauma center
Ventilator-associated pneumonia
Pneumonia, Ventilator-Associated
Retrospective cohort study
Emergency department
Length of Stay
Middle Aged
medicine.disease
Surgery
Logistic Models
Pulmonary aspiration
Wounds and Injuries
Female
business
Subjects
Details
- ISSN :
- 00040010
- Volume :
- 145
- Database :
- OpenAIRE
- Journal :
- Archives of Surgery
- Accession number :
- edsair.doi.dedup.....d399fcc256d1cac47eb87fafd8bba0c8