Bronchoscopy Decreases Ventilator-Associated Pneumonia in Trauma Patients

Abstract

Health care-associated pneumonias (HAPs) are a significant comorbidity seen in hospitalized patients. Traumatic injury is a known independent risk factor for the development of HAP. Trauma-related injuries also contribute to an increase in the rate of pneumonia in mechanically ventilated patients requiring intensive care unit (ICU) treatment. In 2011, the ventilator-associated pneumonia (VAP) rate among ICU patients at our institution (CMMC) increased dramatically. As a result, our infection control specialists performed a focused review of these patients and found a likely association between these infections and patients requiring pre-hospital intubation. Their determination prompted a July 2012 revision of the CMMC Trauma/Surgery Admission ICU protocol for ventilated patients to include bronchoscopy for all patients who have been intubated pre-hospital providing no contraindications were present. Our aim was to ascertain any influence of the protocol change on the rate of VAP. We conducted a retrospective medical record review of trauma patients who were intubated in the field or ED and seen at our institution (an accredited Level 1 trauma center) from 2012 to 2018. Applying the current definition of VAP from the Centers for Disease Control and Prevention (CDC) to data collected from the CMMC trauma registry, we observed a 13% lower VAP rate in the bronchoscopy group ( YB) as compared to the group that did not receive bronchoscopy (NB) ( P < .025). Based on our results, we determined that bronchoscopy performed in this setting does support a statistically significant decrease in the rate of ventilator-associated pneumonia.

Early pneumonia diagnosis decreases ventilator-associated pneumonia rates in trauma population

“…Mirtalaei et al 6 found that prophylactic pipercillin-tazobactam decreased early-onset VAP in intubated patient. Another study by Nannapaneni et al 25 found that patients intubated in the prehospital setting were less likely to develop VAP if they underwent BAL within 24 hours. Thakkar et al 8 found that early antibiotic prophylaxis altered the antibiotic flora of subsequent VAP in intubated trauma patients.…”

The Association Between Bronchoscopy and the Prognoses of Patients With Ventilator-Associated Pneumonia in Intensive Care Units: A Retrospective Study Based on the MIMIC-IV Database

“…Few previous studies have investigated the prognostic effects of bronchoscopy among patients with VAP, with many studying the value of bronchoscopy for diagnosing or preventing VAP ( Timsit et al, 2001 ), or limited to specific populations such as trauma or pediatric patients ( Bush, 2003 ; Nannapaneni et al, 2021 ). The present study included patients with VAP from the large public MIMIC-IV database as the study population.…”