Ventilator-associated pneumonia is more common and of less consequence in trauma patients compared with other critically ill patients

Abstract

Background: Ventilator-associated pneumonia (VAP) incidence is used as a quality measure. We hypothesized that patient and provider factors accounted for the higher incidence of VAP in trauma patients compared with other critically ill patients.

Methods: We conducted a 2-year study of all intubated adult patients at our Trauma Center. VAP was identified according to the Centers for Disease Control and Prevention definition. Groups were compared for the incidence of VAP and outcomes.

Results: The cohort of 2,591 patients included 511 trauma patients and 2,080 nontrauma patients. VAP occurred in 161 patients and more frequently in trauma patients (17.8% vs. 3.4%, p < 0.001). The overall death rate (17.4% vs. 9.8%, p < 0.001) and the death rate for VAP patients (31.4% vs. 11%, p = 0.002) was higher in the nontrauma group. Bronchoalveolar lavage was performed more frequently in the trauma patient group (22.1% vs. 8.9%, p < 0.001), and gram-negative organisms were isolated more commonly in trauma patients (65.9% vs. 30%, p < 0.001), respectively. VAP occurred earlier among the trauma group (mean 8.9 days vs. 14.1 days, p < 0.001). Trauma represented an odds ratio of 3.9 (95% confidence interval 2.4-6.3, p < 0.001) for the development of VAP.

Conclusion: The incidence of VAP is greatest among trauma patients at our institution. The increased use of bronchoalveolar lavage, the earlier onset of VAP, and the higher incidence of gram-negative pneumonias suggest that both patient and provider factors may influence this phenomenon. VAP was associated with increased mortality in the nontrauma group only. These factors should be considered before VAP is applied as a quality indicator.