Is prehospital endobronchial intubation a risk factor for subsequent ventilator associated pneumonia? A retrospective analysis

Abstract

More than half of patients under mechanical ventilation in the intensive care unit (ICU) are field-intubated, which is a known risk factor for ventilator associated pneumonia (VAP). We assessed whether field endobronchial intubation (EBI) is associated with the development of subsequent VAP during the ICU stay. This retrospective, nested case-control study was conducted in a cohort of field-intubated patients admitted to an ICU of a teaching hospital during a three-year period. Cases were defined as field-intubated patients with EBI and controls corresponded to field-intubated patients with proper position of the tracheal tube on admission chest X-ray. Primary endpoint was the development of early VAP. Secondary endpoints included the development of early ventilator associated tracheo-bronchitis, late VAP, duration of mechanical ventilation, length of stay and mortality in the ICU. A total of 145 patients were studied (mean age: 54 ± 19 years; men: 74%). Reasons for field intubation were predominantly multiple trauma (49%) and cardiorespiratory arrest (38%). EBI was identified in 33 patients (23%). Fifty-three patients (37%) developed early or late VAP. EBI after field intubation was associated with a nearly two-fold increase of early VAP, though not statistically significant (30% vs. 17%: p = 0.09). No statistically significant difference was found regarding secondary outcomes. The present study suggests that inadvertent prehospital EBI could be associated with a higher incidence of early-onset VAP. Larger studies are required to confirm this hypothesis. Whether strategies aimed at decreasing the incidence and duration of EBI could reduce the incidence of subsequent VAP remains to be determined.

Early Bronchoscopy Improves Extubation Rates after Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Analysis

“…Malposition of the endotracheal tube close to main carina, in a main bronchus or intermediate bronchus is common in emergency medicine and can be easily corrected under direct visualization during bronchoscopy [ 27 ]. Malposition of the endotracheal tube is a risk factor for ventilator associated pneumonia and may aggravate ventilator-induced lung injury by volutrauma or barotrauma [ 27 , 28 ]. In our population, a correction of the tube was performed in 15.3% of patients, which is in the same range as previous studies with field intubation [ 27 , 28 ].…”

“…Malposition of the endotracheal tube is a risk factor for ventilator associated pneumonia and may aggravate ventilator-induced lung injury by volutrauma or barotrauma [ 27 , 28 ]. In our population, a correction of the tube was performed in 15.3% of patients, which is in the same range as previous studies with field intubation [ 27 , 28 ].…”

Risk factors and preventable strategies of ventilator-associated pneumonia: the role of nursing care and epidemiological surveillance

“…In their guidelines regarding the course of action in HAP/VAP, the American Thoracic Society (ATS) and in the composition. Analysis of the literature makes it clear that there are also other risk factors, such as the following: the number of nurses caring for patients in the ICU [35], the duration of hospitalization [21,36], the duration of hospital stay in ICU [21,31,36], emergency surgery, perioperative blood transfusions [27], and pre-hospital bronchial intubation [37]. In the case of VAP risk factors, which are dependent on medical procedures, it seems obvious that preventive strategies to reduce the incidence rates should be implemented.…”

Multi-criteria risk evaluation model for developing ventilator-associated pneumonia

“…If re-intubation is required, the risk of developing VAP increases (Gao et al 2016 ), while initial intubation circumstances can also contribute to the risk of infection. Pre-hospital intubation is considered to be a risk factor for developing VAP (Arumugam et al 2018 ), some evidence additionally pointing to a possible association between pre-hospital endobronchial intubation and the early onset of VAP (Padilla et al 2019 ). Male gender, immunodeficiency and old age are also linked with an increased incidence of VAP, according to the recent literature (Kock and Maurici 2018 ; Timsit et al 2017 ).…”