title: Patient transport from intensive care increases the risk of developing ventilator-associated pneumonia.
abstract: 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.
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Kollef
authors.forename: B
authors.initials: B
authors.lastname: Von Harz
authors.forename: D
authors.initials: D
authors.lastname: Prentice
authors.forename: S D
authors.initials: SD
authors.lastname: Shapiro
authors.forename: P
authors.initials: P
authors.lastname: Silver
authors.forename: R
authors.initials: R
authors.lastname: St John
authors.forename: E
authors.initials: E
authors.lastname: Trovillion
mesh_terms: 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
chemical_list: D000336:Aerosols