TY  - JOUR
T1  - TIming of intubation and ventilator-associated pneumonia following injury
AU  - Evans HL, Zonies DH, Warner KJ, et al
Y1  - 2010/11/15
N1  - 10.1001/archsurg.2010.239
JO  - Archives of Surgery
SP  - 1041
EP  - 1046
VL  - 145
IS  - 11
N2  - Hypothesis 
    In an emergency medical system with established rapid-sequence intubation protocols, prehospital (PH) intubation of patients with trauma is not associated with a higher rate of ventilator-associated pneumonia (VAP) than emergency department (ED) intubation.Design 
    Retrospective observational cohort.Setting 
    Level I trauma center.Patients 
    Adult patients with trauma intubated in a PH or an ED setting from July 1, 2007, through July 31, 2008.Main Outcome Measures 
    Diagnosis of VAP by means of bronchoscopic alveolar lavage or clinical assessment when bronchoscopic alveolar lavage was impossible. Secondary outcomes included time to VAP, length of hospitalization, and in-hospital mortality.Results 
    Of 572 patients, 412 (72.0%) underwent PH intubation. The ED group was older than the PH group (mean ages, 46.4 vs 39.1 years; P < .001) and had a higher incidence of blunt injury (142 [88.8%] vs 322 [78.2%]; P = .002). The mean (SD) lowest recorded ED systolic blood pressure was lower in the ED group (102.8 [1.9] vs 111.4 [1.2] mm Hg; P < .001), despite similar mean injury severity scores in both groups (27.2 [0.7] vs 27.0 [1.1]; P = .94). There was no difference in the mean rate of VAP (30 [18.8%] vs 71 [17.2%]; P = .66) or mean time to diagnosis (8.1 [1.2] vs 7.8 [1.0] days; P = .89). Logistic regression analysis identified history of drug abuse, lowest recorded ED systolic blood pressure, and injury severity score as 3 independent factors predictive of VAP.Conclusions 
    Prehospital intubation of patients with trauma is not associated with higher risk of VAP. Further investigation of intubation factors and the incidence and timing of aspiration is required to identify potentially modifiable factors to prevent VAP.
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.2010.239
UR  - http://dx.doi.org/10.1001/archsurg.2010.239
ER  -