Patient transport from intensive care increases the risk of developing ventilator-associated pneumonia.
OBJECTIVE
To determine whether patient transport out of the ICU is associated with an increased risk of developing ventilator-associated pneumonia.


METHODS
Prospective cohort study.


METHODS
ICUs of Barnes-Jewish Hospital, a university-affiliated teaching hospital.


METHODS
Five hundred twenty-one ICU patients requiring mechanical ventilation for > 12 h.


METHODS
Prospective patient surveillance and data collection.


RESULTS
The primary outcome measure was the development of ventilator-associated pneumonia. A total of 273 (52.4%) mechanically ventilated patients required at least one transport out of the ICU while 248 (47.6%) patients did not undergo transport. Sixty-six (24.2%) of the transported patients developed ventilator-associated pneumonia compared with 11 (4.4%) patients in the group not undergoing transport (relative risk=5.5; 95% confidence interval [CI]=2.9 to 10.1; p<0.001). Multiple logistic regression analysis demonstrated that a preceding episode of transport out of the ICU was independently associated with the development of ventilator-associated pneumonia (adjusted odds ratio=3.8; 95% CI=2.6 to 5.5; p<0.001). Other variables independently associated with the development of ventilator-associated pneumonia included reintubation, presence of a tracheostomy, administration of aerosols, and male gender.


CONCLUSIONS
We conclude that patient transport out of the ICU is associated with an increased risk for the development of ventilator-associated pneumonia.
Kollef
M H
MH
Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
Von Harz
B
B
Prentice
D
D
Shapiro
S D
SD
Silver
P
P
St John
R
R
Trovillion
E
E
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000336:Aerosols; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D003422:Critical Care; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer; D018410:Pneumonia, Bacterial / Q000209:etiology*; D011159:Population Surveillance; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014139:Tracheostomy
D000336:Aerosols