Risk factors for ventilator-associated pneumonia in trauma patients: A descriptive analysis

Arumugam, S.; Mudali, Insolvisagan Natesa; Strandvik, Gustav; El‐Menyar, Ayman; Al-Hassani, Ammar; Al-Thani, Hassan

doi:10.5847/wjem.j.1920-8642.2018.03.007

Cited by 50 publications

(64 citation statements)

References 26 publications

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“…Other studies show that the impact of location of intubation in predicting the risk of VAP could be discrepant in trauma patients comparing prehospital and trauma room intubation, and some cases are significant only when other variables are included in the models, as chest injury (crude OR 1.16 p = .600, adjusted OR 0.17, p < .003). [32] In the univariate analysis, the measurements of NAS show good capacity to predict the occurrence of VAP. The NASad, NAS-i, NAS-ri, NAS-m and NAS-paas were associated of VAP occurrence.…”

Section: Discussionmentioning

confidence: 97%

The nursing workload assessed through the Nursing Activities Score as a predictor for the occurrence of ventilator-associated pneumonia in an adult intensive care unit

Gomes¹,

Röder²,

Cunha³

et al. 2019

JNEP

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Objective: Evaluate the relation of nursing workload, evaluated by the Nursing Activities Score (NAS), with the occurrence of Ventilator-associated Pneumonia (VAP) in an Intensive Care Unit (ICU) and the impact of VAP on hospitalization costs.Methods: Retrospective cohort study in Adult ICU of a high complexity Brazilian university hospital. The profile, outcomes, costs, and daily NAS from patients were collected. We also proposed some workload indicators based on NAS daily evaluation.Results: The study included 195 patients, 27.17% diagnosed with VAP. VAP was more prevalent in patients diagnosed with trauma on admission. The total costs of care were higher for VAP patients. In all multivariate models tested were predictive for VAP: the patient's intubation that occurs in days prior of the ICU admission day (higher risk if occurs in days prior the ICU admission day) and ventilation time prior ICU (higher risk if higher time). We found others predictors, but these were dependent on the model tested. Additional risk predictors were tracheostomy, propofol use, neuromuscular blocker use and the higher NAS from admission. The protective factors found were the percentage of adequacy of the assignment based in NAS that measure if the workload measured by the NAS was offered and the increment in NAS during the ventilation time.Conclusions: The offering of an adequate nursing work scale (adequate number of professionals for the care), as a function of the nursing workload measured by the NAS, could be effective in the reduction of VAP, hospital stay time and hospital costs.

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Section: Discussionmentioning

confidence: 97%

The nursing workload assessed through the Nursing Activities Score as a predictor for the occurrence of ventilator-associated pneumonia in an adult intensive care unit

Gomes¹,

Röder²,

Cunha³

et al. 2019

JNEP

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“…Between January 2013 and January 2018, we identified 113 patients who were admitted to our Emergency Center with the diagnosis of sepsis and SA-AKI. We reviewed epidemiological literature related to infections among patients receiving intensive care and identified the four most common sites of infection, [17][18][19][20] accounting for 90% of infections in patients with sepsis. [17] Evidence showed that the lungs were the primary source of such infections.…”

Section: Study Design Setting and Patient Populationmentioning

confidence: 99%

A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function

Fan

Jiang

Chen

et al. 2020

World Journal of Emergency Medicine

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BACKGROUND: Hospital mortality rates are higher among patients with sepsis-associated acute kidney injury (SA-AKI) than among patients with sepsis. However, the pathogenesis underlying SA-AKI remains unclear. We hypothesized that the source of infection affects development of SA-AKI. We aim to explore the relationship between the anatomical source of infection and outcome in patients with SA-AKI. METHODS: Between January 2013 and January 2018, 113 patients with SA-AKI admitted to our Emergency Center were identifi ed and divided into two groups: those with pulmonary infections and those with other sources of infection. For each patient, we collected data from admission until either discharge or death. We also recorded the clinical outcome after 90 days for the discharged patients. RESULTS: The most common source of infection was the lung (52/113 cases, 46%), followed by gastrointestinal (GI) (25/113 cases, 22.1%) and urinary (22/113, 19.5%) sources. Our analysis showed that patients with SA-AKI had a significantly worse outcome (30/52 cases, P<0.001) and poorer kidney recovery (P=0.015) with pulmonary sources of infection than those infected by another source. Data also showed that patients not infected by a pulmonary source more likely experienced shock (28/61 cases, P=0.037). CONCLUSION: This study demonstrated that the source of infection infl uenced the outcome of SA-AKI patients in an independent manner. Lung injury may influence renal function in an asyet undetermined manner as the recovery of kidney function was poorer in SA-AKI patients with a pulmonary source of infection.

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“…As a general principle, it is actually required that all variables identified as significant (P < .2) in the univariate analysis should be included in the multivariate analysis for statistical adjustment. 4 As multicollinearity among candidate independent variables was not correctly applied, we argue that some important factors associated with an increased risk of post-OLT AKI would have been missed and adjusted odds ratios of risk factors for AKI identified in this study might have been biased.…”

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confidence: 84%

“…3 Furthermore, small increases of early postoperative sCr adjusted for FB can significantly improve diagnosis and severity classifications of AKI. 4 As stage 1 AKI defined by small sCr increases in this study was mostly frequent with an incidence of up to 54%, we were concerned that not adjusting sCr for FB would have confounded incidence and severity of AKI.…”

mentioning

confidence: 90%

Assessing association of cumulative fluid balance with acute kidney injury after orthotopic liver transplantation

2020

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Risk factors for ventilator-associated pneumonia in trauma patients: A descriptive analysis

Abstract: In trauma, the risk of developing VAP is multifactorial. However, the location of intubation and presence of chest injury could play an important role.

Cited by 50 publications

References 26 publications

The nursing workload assessed through the Nursing Activities Score as a predictor for the occurrence of ventilator-associated pneumonia in an adult intensive care unit

The nursing workload assessed through the Nursing Activities Score as a predictor for the occurrence of ventilator-associated pneumonia in an adult intensive care unit

A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function

Assessing association of cumulative fluid balance with acute kidney injury after orthotopic liver transplantation

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