Ventilator-associated pneumonia leading to acute lung injury after trauma: importance of Haemophilus influenzae.

Abstract

BACKGROUND:

Ventilator-associated pneumonia is a clear risk factor for acute lung injury which has been poorly described in trauma patients. This prospective study was undertaken to estimate the incidence of such ventilator-associated pneumonia leading to acute lung injury, the risk factors, and the associated morbidity and mortality in a group of multiple trauma patients.

METHODS:

Trauma patients who were mechanically ventilated and survived at least 24 h were included. Ventilator-associated pneumonia was confirmed by a bacterial culture of a blind protected telescoping catheter with at least 10 colony-forming units/ml of at least one pathogen. Episodes of acute lung injury were prospectively recorded.

RESULTS:

Ventilator-associated pneumonia was documented in 78 patients of the 175 included (44%) and led to the development of ventilator-associated pneumonia acute lung injury in 18 patients (23%). The sole independent risk factor for ventilator-associated pneumonia leading to acute lung injury was the presence of Haemophilus influenzae (hazard ratio, 8.8; 95% confidence interval, 2.7-28.6). Eleven (61%) of the 18 patients with ventilator-associated pneumonia leading to acute lung injury had development of a ventilator-associated pneumonia recurrence, as compared with 20 (33%) of the 60 patients with ventilator-associated pneumonia alone (P = 0.03). Seven (39%) of the 18 trauma patients with ventilator-associated pneumonia leading to acute lung injury died, as compared with 9 (15%) of the 60 trauma patients with ventilator-associated pneumonia alone (P = 0.04).

CONCLUSION:

Acute lung injury complicated the course of 15% of ventilator-associated pneumonia in trauma patients. H. influenzae seemed to be one of the most frequent bacteria involved and the sole risk factor identified. Occurrence of ventilator-associated pneumonia leading to acute lung injury modified the prognosis of trauma patients.

• Authors: François Stéphan, Nejma Mabrouk, François Decailliot, Christophe Delclaux, Patrick Legrand
• Journal: Anesthesiology (Anesthesiology) Vol. 104 Issue 2 Pg. 235-41 (Feb 2006) ISSN: 0003-3022 [Print] United States
• PMID: 16436840 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Cross Infection (epidemiology, etiology, mortality)
• Female
• Haemophilus Infections (epidemiology, etiology, mortality)
• Haemophilus influenzae
• Humans
• Lung Diseases (epidemiology, etiology, mortality)
• Male
• Middle Aged
• Pneumonia (epidemiology, etiology, mortality)
• Risk Factors
• Treatment Outcome
• Ventilators, Mechanical (adverse effects)
• Wounds and Injuries (complications, mortality, therapy)