Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 15;12(1):176.
doi: 10.3390/antibiotics12010176.

Infection-Related Ventilator-Associated Complications in Critically Ill Patients with Trauma: A Retrospective Analysis

Emanuele Russo  1 , Marta Velia Antonini  1   2 , Andrea Sica  1 , Cristian Dell'Amore  1 , Costanza Martino  3 , Emiliano Gamberini  4 , Luca Bissoni  1 , Alessandro Circelli  1 , Giuliano Bolondi  1 , Domenico Pietro Santonastaso  1 , Francesco Cristini  5 , Luigi Raumer  5 , Fausto Catena  6 , Vanni Agnoletti  1
Affiliations

Infection-Related Ventilator-Associated Complications in Critically Ill Patients with Trauma: A Retrospective Analysis

Emanuele Russo et al. Antibiotics (Basel). .

Abstract

Background: Trauma is a leading cause of death and disability. Patients with trauma undergoing invasive mechanical ventilation (IMV) are at risk for ventilator-associated events (VAEs) potentially associated with a longer duration of IMV and increased stay in the intensive care unit (ICU).

Methods: We conducted a retrospective cohort study aimed to evaluate the incidence of infection-related ventilator-associated complications (IVACs), possible ventilator-associated pneumonia (PVAP), and their characteristics among patients experiencing severe trauma that required ICU admission and IMV for at least four days. We also determined pathogens implicated in PVAP episodes and characterized the use of antimicrobial therapy.

Results: In total, 88 adult patients were included in the main analysis. In this study, we observed that 29.5% of patients developed a respiratory infection during ICU stay. Among them, five patients (19.2%) suffered from respiratory infections due to multi-drug resistant bacteria. Patients who developed IVAC/PVAP presented lower total GCS (median value, 7; (IQR, 9) vs. 12.5, (IQR, 8); p = 0.068) than those who did not develop IVAC/PVAP.

Conclusions: We observed that less than one-third of trauma patients fulfilling criteria for ventilator associated events developed a respiratory infection during the ICU stay.

Keywords: anti-infective agents; antimicrobial stewardship; intensive care unit; mechanical ventilators; trauma; traumatic brain injury; ventilator associated pneumonia.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of study population selection; gray boxes, subjects excluded from the main analysis (see methods). ICU: intensive care unit; LoS: length of stay; h: hours; IMV: invasive mechanical ventilation.
Figure 2
Figure 2
Patients admitted with trauma diagnoses during the study period; among these were patients on mechanical ventilation for more than 96 h (potentially fulfilling the criteria for IVAC of PVAP development), patients developing respiratory infection fulfilling criteria for VACs, and patients developing IVACs/PVAPs. For the last group, percentages are over total admissions (upper line) and over the number of individuals on MV for more than 96 h (lower line, between parenthesis). MV: mechanical ventilation; h: hours; IVAC: infection-related ventilator-associated complications; PVAP: possible ventilator-associated pneumonia; VAC: ventilator-associated conditions.
Figure 3
Figure 3
Bacteria detected in the respiratory tract samples of patients with IVAC/PVAP (total number of positive samples). The numbers above the columns represent the relative percentage of the total number of positive samples. Asterisks indicate pathogens that presented multi-drug resistance in at least one sample. IVAC: infection-related ventilator-associated complications; PVAP: possible ventilator-associated pneumonia.
See this image and copyright information in PMC

References

    1. Bivens M.J., Fritz C.L., Burke R.C., Schoenfeld D.W., Pope J.V. State-by-state estimates of avoidable trauma mortality with early and liberal versus delayed or restricted administration of tranexamic acid. BMC Emerg. Med. 2022;22:191. doi: 10.1186/s12873-022-00741-2. - DOI - PMC - PubMed
    1. Baker S.P., O’Neill B., Haddon W., Jr., Long W.B. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J. Trauma. 1974;14:187–196. doi: 10.1097/00005373-197403000-00001. - DOI - PubMed
    1. Baker S.P., O’Neill B. The injury severity score: An update. J. Trauma. 1976;16:882–885. doi: 10.1097/00005373-197611000-00006. - DOI - PubMed
    1. Committee on Medical Aspects of Automotive Safety Rating the severity of tissue damage. I. The abbreviated scale. JAMA. 1971;215:277–280. doi: 10.1001/jama.1971.03180150059012. - DOI - PubMed
    1. Van Ditshuizen J.C., Southwest D.T.R., Sewalt C.A., Palmer C.S., Van Lieshout E.M.M., Verhofstad M.H.J., Hartog D.D. Dutch Trauma Registry Southwest. The definition of major trauma using different revisions of the abbreviated injury scale. Scand. J. Trauma. Resusc. Emerg. Med. 2021;29:71. doi: 10.1186/s13049-021-00873-7. - DOI - PMC - PubMed

LinkOut - more resources