title: Supine position and nonmodifiable risk factors for ventilator-associated pneumonia in trauma patients.
abstract: BACKGROUND
  We studied trauma-specific conditions precluding semiupright positioning and other nonmodifiable risk factors for their influence on ventilator-associated pneumonia (VAP).
  
  
  METHODS
  We performed a retrospective study at a Level I trauma center from 2008 to 2012 on ICU patients aged ≥15, who were intubated for more than 2 days. Using backward logistic regression, a composite of 4 factors (open abdomen, acute spinal cord injury, spine fracture, spine surgery) that preclude semiupright positioning (supine composite) and other variables were analyzed.
  
  
  RESULTS
  In total, 77 of 374 (21%) patients had VAP. Abbreviated Injury Score head/neck greater than 2 (odds ratio [OR] 2.79, P = .006), esophageal obturator airway (OR 4.25, P = .015), red cell/plasma transfusion in the first 2 intensive care unit days (OR 2.59, P = .003), and 11 or more ventilator days (OR 17.38, P < .0001) were significant VAP risk factors, whereas supine composite, scene vs emergency department airway intervention, brain injury, and coma were not.
  
  
  CONCLUSIONS
  Factors that may temporarily preclude semiupright positioning in intubated trauma patients were not associated with a higher risk for VAP.
authors: Department of Surgery, Inova Fairfax Hospital, Falls Church, VA, USA. Electronic address: christopher.michetti@inova.org.
authors: Christopher P
authors: CP
authors: Michetti
authors: Department of Surgery, Inova Fairfax Hospital, Falls Church, VA, USA.
authors: Heather A
authors: HA
authors: Prentice
authors: Department of Surgery, Inova Fairfax Hospital, Falls Church, VA, USA.
authors: Jennifer
authors: J
authors: Rodriguez
authors: Department of Surgery, Inova Fairfax Hospital, Falls Church, VA, USA.
authors: Anna
authors: A
authors: Newcomb
mesh_terms: D015998:Abbreviated Injury Scale; D000005:Abdomen / Q000601:surgery; D000328:Adult; D016913:Blood Component Transfusion; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D016015:Logistic Models; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013124:Spinal Injuries / Q000601:surgery; D016683:Supine Position; D014193:Trauma Centers; D014768:Virginia / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology*
keywords: Open abdomen; Risk factors; Semiupright position; Supine position; Trauma; Ventilator-associated pneumonia