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Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

  • Park, Hyun Oh (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine) ;
  • Kang, Dong Hoon (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Moon, Seong Ho (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine) ;
  • Yang, Jun Ho (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine) ;
  • Kim, Sung Hwan (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine) ;
  • Byun, Joung Hun (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine)
  • Received : 2016.10.25
  • Accepted : 2017.04.07
  • Published : 2017.10.05

Abstract

Background: Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. Results: Forty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029). Conclusion: Severe pulmonary contusion (pulmonary lung contusion score 6-12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

Keywords

References

  1. O'Grady NP, Murray PR, Ames N. Preventing ventilatorassociated pneumonia: does the evidence support the practice? JAMA 2012;307:2534-9.
  2. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-32. https://doi.org/10.1016/j.ajic.2008.03.002
  3. Green GM, Jakab GJ, Low RB, Davis GS. Defense mechanisms of the respiratory membrane. Am Rev Respir Dis 1977;115:479-514.
  4. Byun JH, Kim HY. Factors affecting pneumonia occurring to patients with multiple rib fractures. Korean J Thorac Cardiovasc Surg 2013;46:130-4. https://doi.org/10.5090/kjtcs.2013.46.2.130
  5. Oyetunji TA, Jackson HT, Obirieze AC, et al. Associated injuries in traumatic sternal fractures: a review of the National Trauma Data Bank. Am Surg 2013;79:702-5.
  6. Aukema TS, Beenen LF, Hietbrink F, Leenen LP. Validation of the Thorax Trauma Severity Score for mortality and its value for the development of acute respiratory distress syndrome. Open Access Emerg Med 2011;3:49-53.
  7. Kim JJ, Shin JH, Jin W, et al. The value of grading of pulmonary contusion by the chest CT scanning. J Korean Soc Emerg Med 2004;15:452-5.
  8. Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187-96. https://doi.org/10.1097/00005373-197403000-00001
  9. Antonelli M, Moro ML, Capelli O, et al. Risk factors for early onset pneumonia in trauma patients. Chest 1994;105:224-8. https://doi.org/10.1378/chest.105.1.224
  10. Sagarin MJ, Barton ED, Chng YM, Walls RM; National Emergency Airway Registry Investigators. Airway management by US and Canadian emergency medicine residents: a multicenter analysis of more than 6,000 endotracheal intubation attempts. Ann Emerg Med 2005;46:328-36. https://doi.org/10.1016/j.annemergmed.2005.01.009
  11. Demirhan R, Onan B, Oz K, Halezeroglu S. Comprehensive analysis of 4205 patients with chest trauma: a 10-year experience. Interact Cardiovasc Thorac Surg 2009;9:450-3. https://doi.org/10.1510/icvts.2009.206599
  12. Clark GC, Schecter WP, Trunkey DD. Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma 1988;28:298-304. https://doi.org/10.1097/00005373-198803000-00004
  13. Wardhan R. Assessment and management of rib fracture pain in geriatric population: an ode to old age. Curr Opin Anaesthesiol 2013;26:626-31. https://doi.org/10.1097/01.aco.0000432516.93715.a7
  14. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887-92. https://doi.org/10.1097/00003246-199905000-00020
  15. Rodriguez JL, Gibbons KJ, Bitzer LG, Dechert RE, Steinberg SM, Flint LM. Pneumonia: incidence, risk factors, and outcome in injured patients. J Trauma 1991;31:907-12. https://doi.org/10.1097/00005373-199107000-00005
  16. Lively MW. Early onset pneumonia following pulmonary contusion: the case of Stonewall Jackson. Mil Med 2012;177:315-7. https://doi.org/10.7205/MILMED-D-11-00272
  17. Odell DD, Peleg K, Givon A, et al. Sternal fracture: isolated lesion versus polytrauma from associated extrasternal injuries: analysis of 1,867 cases. J Trauma Acute Care Surg 2013;75:448-52. https://doi.org/10.1097/TA.0b013e31829e227e
  18. Cohn SM. Pulmonary contusion: review of the clinical entity. J Trauma 1997;42:973-9. https://doi.org/10.1097/00005373-199705000-00033
  19. Wagner RB, Jamieson PM. Pulmonary contusion: evaluation and classification by computed tomography. Surg Clin North Am 1989;69:31-40. https://doi.org/10.1016/S0039-6109(16)44732-8
  20. Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma 2000;49:496-504. https://doi.org/10.1097/00005373-200009000-00018
  21. Martinez Casas I, Amador Marchante MA, Paduraru M, Fabregues Olea AI, Nolasco A, Medina JC. Thorax trauma severity score: is it reliable for patient's evaluation in a secondary level hospital? Bull Emerg Trauma 2016;4:150-5.

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