title: Ventilator-associated pneumonia after combined burn and trauma is caused by associated injuries and not the burn wound.
abstract: An increased risk of ventilator-associated pneumonia (VAP) has previously been demonstrated in trauma patients urgently intubated in the prehospital (ie, field) and emergency department (ED) settings. This study investigated the impact of urgent intubation on subsequent VAP in patients who sustained both a burn injury and a traumatic injury. We undertook a retrospective review of both trauma registry data and medical records for all patients with combined thermal and traumatic injuries admitted to a single verified burn center and level I trauma center. Patients undergoing field or ED intubation during the 5-year period ending December 2002 were identified and studied. Data abstracted included admission demographics and vital signs, presence of inhalation injury, location at the time of intubation, presence of associated injury, percentage TBSA burn, hospital and intensive care unit length of stay, and hospital day of VAP diagnosis. Seventy-eight of the 3388 patients (2.3%) admitted during the study period sustained a combination of burn wounds and trauma and underwent urgent field or ED intubation. The majority of patients were men (71%), with a mean age of 46 +/- 24 years. There was one failed oral intubation, which required cricothyroidotomy. The location of the patient at the time of intubation was ED, 66%; burn center ED, 17%; and field, 17%. Eighty percent of all patients were diagnosed with an inhalation injury. VAP was diagnosed in 39 patients (50%), with a mean time to diagnosis of 10 +/- 9 days. TBSA burn, smoke inhalation, and time (in days) to diagnosis of VAP were not independent risk factors for the occurrence of pneumonia in any of the 3 groups. However, those intubated at the initial ED were more likely to develop VAP (P = .028) compared to those intubated in the field or in the burn center. The incidence of associated injuries was significantly greater (P < .0001) in the initial ED group. Only a small percentage of burn patients also sustain blunt trauma. VAP occurs in 50% of the patients requiring urgent intubation. Independent risk factors appear to be intubation at an initial ED before transfer and associated injuries.
authors.affiliation: Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Eckert
authors.forename: Terence E
authors.initials: TE
authors.lastname: Wade
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Davis
authors.forename: Fred A
authors.initials: FA
authors.lastname: Luchette
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Esposito
authors.forename: Stathis J
authors.initials: SJ
authors.lastname: Poulakidas
authors.forename: John M
authors.initials: JM
authors.lastname: Santaniello
authors.forename: Richard L
authors.initials: RL
authors.lastname: Gamelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000150:complications* / Q000401:mortality; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology*; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000150:complications*