Ventilator-Associated Pneumonia Risk in Prehospital or Emergency Room Intubated Trauma Patients

Author(s):
Raj Malhotra; Brian Zeng; Keshav Kumar; Helen Horng; Christopher Graham; Joanelle Bailey; Nina Glass

Background:

Ventilator-associated pneumonia (VAP) increases patient length of stay, morbidity, and mortality in Intensive Care Units (ICUs). Previous studies have demonstrated mixed results regarding prehospital and/or emergency department intubations (PHI and EDI) as risk factors for developing VAP in trauma patients.

Hypothesis:

We hypothesized that VAP would be associated with PHI/EDI and therefore screening for pneumonia with BAL on all PHI/EDI patients to initiate earlier therapy would be warranted. We therefore sought to describe our baseline data before initiating a quality improvement project.

Methods:

We reviewed trauma patients from 01/2019 through 05/2022 admitted to the intensive care unit. Patient demographics, injury characteristics, intubation status, and VAP status were captured from our institution’s trauma registry or chart review. We compared baseline and injury characteristics between VAP and non-VAP patients using comparative statistics and then stepwise logistic regression to identify potential risk factors in VAP.

Results:

A higher percentage of patients who developed VAP were PHI/EDI compared to those who were not initially intubated (22% vs. 15%, p=0.03). However, when controlling for baseline and injury characteristics by logistic regression, PHI/EDI status was not significantly associated with VAP (OR=0.93, 95% CI=0.6-1.4, p=0.72). When comparing the PHI and EDI groups, there were no significant differences.

Conclusions:

While there were high rates of VAP in patients intubated in the prehospital or emergency department setting, this did not appear to be correlated with that early intubation, but rather with baseline characteristics including higher injury severity. Despite this negative finding, we hypothesize quantitative bronchoalveolar lavage in the trauma bay will help identify these VAPs earlier and allow for early initiation of therapy with improved outcomes. Further study is needed to identify optimal care for VAP in these very high-risk patients.