Risk and prognostic factors of ventilator-associated pneumonia in trauma patients.
OBJECTIVE
To assess the risk and prognostic factors of ventilator-associated pneumonia in trauma patients, with an emphasis on the inflammatory response.


METHODS
Case-control study.


METHODS
Trauma intensive care unit.


METHODS
Of 190 consecutive mechanically ventilated patients, those with microbiologically confirmed pneumonia (n = 62) were matched with 62 controls without pneumonia.


METHODS
None.


RESULTS
Clinical, microbiological, and outcome variables were recorded. Cytokines were measured in serum and blind bronchoalveolar lavage specimens at onset of pneumonia. Multivariate analyses of risk and prognostic factors for ventilator-associated pneumonia were done. Increased severity of head and neck injury (odds ratio, 11.9; p < .001) was the only independent predictor of pneumonia. Among patients with pneumonia, serum levels of interleukin-6 (p = .019) and interleukin-8 (p = .036) at onset of pneumonia were higher in nonresponders to treatment. Moreover, serum levels of tumor necrosis factor-alpha (p = .028) and interleukin-6 (p = .007) at onset of pneumonia were higher in nonsurvivors. Mortality in the intensive care unit was 23% in cases and controls. Nonresponse to antimicrobial treatment (odds ratio, 22.2; p = .001) and the use of hyperventilation (p = .021) were independent predictors of mortality in the intensive care unit for patients with pneumonia.


CONCLUSIONS
Severe head and neck trauma is strongly associated with ventilator-associated pneumonia. A higher inflammatory response is associated with nonresponse to treatment and mortality among patients with pneumonia. Although pneumonia did not influence mortality, nonresponse to treatment independently predicted mortality among these patients.
Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain.
Manuela
M
Cavalcanti
Miquel
M
Ferrer
Ricard
R
Ferrer
Ramon
R
Morforte
Angel
A
Garnacho
Antoni
A
Torres
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D018410:Pneumonia, Bacterial / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D014947:Wounds and Injuries / Q000628:therapy*