title: Duration of prehospital intubation is not a risk factor for development of early ventilator-associated pneumonia.
abstract: OBJECTIVE
  Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality among critically ill patients with trauma. Few VAP prevention strategies have been studied in the prehospital environment. The objectives of this study are to measure the association between duration of prehospital intubation and intubation location with subsequent incidence of early (within 5 days) VAP.
  
  
  METHODS
  Single-center retrospective cohort study of all intubated adult (age≥18 years) patients with trauma presenting to a 711-bed Midwestern Level I trauma center between January 2005 and December 2011 (n=860).
  
  
  RESULTS
  Thirty-five patients (6.4%) were diagnosed as having early VAP during the study period. Using multivariable logistic regression to adjust for age, injury severity score, and year (corresponding to VAP bundle implementation), the duration of intubation prior to hospital admission was not associated with subsequent diagnosis of VAP (adjusted odds ratio, 0.90 per hour; 95% confidence interval, 0.70-1.15). Location of intubation was similarly not associated with VAP.
  
  
  CONCLUSIONS
  Duration of prehospital intubation and intubation location were not different in patients with trauma who developed early VAP. Further prospective analyses should be conducted to better elucidate the effect of prehospital management on the development of traditionally in-hospital complications.
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: nicholas-mohr@uiowa.edu.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Mohr
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Injury Prevention Research Center, University of Iowa College of Public Health, Iowa City, IA.
authors.forename: Karisa K
authors.initials: KK
authors.lastname: Harland
authors.affiliation: Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA.
authors.forename: Dionne
authors.initials: D
authors.lastname: Skeete
authors.affiliation: Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine, Iowa City, IA.
authors.forename: Kent
authors.initials: K
authors.lastname: Pearson
authors.affiliation: Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA.
authors.forename: Kent
authors.initials: K
authors.lastname: Choi
mesh_terms: D000328:Adult; D000367:Age Factors; D016638:Critical Illness; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D015994:Incidence; D007440:Intubation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000628:therapy*
keywords: Emergency medical services; Emergency medicine; Pneumonia ventilator-associated; Prevention and control; Wounds and injuries