Abstract:
Objective: To study the occurrence, risk factors and outcome of Ventilator Associated Pneumonia (VAP) in trauma patients. Study Design: Prospective observational study. Place and Duration of Study: Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi Pakistan, from Jul to Dec 2019. Methodology: All trauma patients, above 12 years, placed on mechanical ventilation in the ER or ICU, were enrolled. Patients that developed a Clinical Pulmonary Infection Score of >6 were diagnosed with Ventilator Associated Pneumonia. Results: A total of 113 patients were enrolled. Mean age was 32.9 ± 14.4 years; 105 (92.9%) were males. Thirty-eight (33.6%) patients developed VAP. Patients with VAP, compared to non-VAP, had a longer Emergency Room (ER) stay of 7.8 ± 10.1 vs 4.7 ± 7.4 days (p-value 0.013), greater ventilator days of 18.5 ± 12.6 vs 7.9 ± 5.5 (p-value 0.001), longer hospital stay of >14 days in 65.8% vs 33.3% (p-value 0.001) and higher mortality of 65.8% vs 56.0% (p-value 0.213). Nurse to patient ratio and infection control measures for prevention of VAP were significantly reduced in Emergency Room compared to Intensive Care Unit (pvalue 0.001). Of 43 respiratory isolates in 38 VAP patients, 40 (93%) were gram negatives of which 23 (57.5%) were multidrug resistant with polymyxins as the only therapeutic option. Conclusion: There is a high burden of VAP in patients with trauma. Prolonged retention in the ER is a significant risk factor for VAP, due to understaffing and poor infection control in the emergency setting. Policies must be instituted to improve infection control and minimize ER stay of patients.
Page(s):
1476-1480
DOI:
DOI not available
Published:
Journal: Pakistan Armed Forces Medical Journal, Volume: 71, Issue: 4, Year: 2021
Keywords:
Trauma
,
Risk Factors
,
Ventilator Associated Pneumonia VAP
,
Intensive care unit ICU
,
Emergency room ER