Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences · 2026
[Risk factors for ventilator-associated pneumonia in patients with chest trauma in intensive care unit].
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Zhao Jie, Fu Chun, Zhao Xiujuan, Xue Haiyan, Li Shu, Wang Zhenzhou, Zhu Fengxue
Аннотация
OBJECTIVE: To explore the risk factors associated with ventilator-associated pneumonia (VAP) in the patients with chest trauma in the intensive care unit (ICU).
METHODS: A retrospective analysis was conducted on the clinical data of 124 adult trauma patients admitted to the surgical ICU of Peking University People' s Hospital between June 2019 and June 2023. These patients underwent tra-cheal intubation within 24 hours of admission and received mechanical ventilation for more than 48 hours. Based on whether VAP occurred during hospitalization, the patients were divided into a VAP group (46 cases) and a non-VAP group (78 cases). Lasso regression analysis was employed for variable selection, followed by Logistic regression analysis to determine the risk factors for VAP in these patients with chest trauma in the ICU.
RESULTS: The multivariate regression analysis indicated that the injury severity score (ISS) (OR=1.08, 95%CI: 1.02-1.14, P=0.007) and tracheostomy (OR=4.61, 95%CI: 1.74-13.11, P=0.003) were independent risk factors for VAP in the patients with chest trauma (P < 0.05). Among all VAP cases, early-onset VAP was observed in 19 patients, while late-onset VAP was observed in 27 patients. The most common pathogen in all VAP cases was Klebsiella pneumoniae, identified in 18 cases (39.1%). In early-onset VAP, Klebsiella pneumoniae was the most frequently detected pathogen, found in 10 cases (52.6%). Conversely, in late-onset VAP, Pseudomonas aeruginosa and Acinetobacter baumannii were the most prevalent pathogens, each appearing in 10 cases (37.0%).
CONCLUSION: The occurrence of VAP in the patients with chest trauma in the ICU was influenced by multiple factors. This study identified that a higher ISS and the presence of a tracheostomy were independent risk factors for VAP in these patients. These findings suggest that in clinical practice, special attention should be given to the chest trauma patients with high ISS scores, and the timing and necessity of tracheostomy should be carefully considered to reduce the incidence of VAP and improve patient outcomes. Furthermore, the study highlights the importance of early identification and appropriate management of the patients at higher risk for developing VAP. By recognizing the significance of these risk factors, healthcare providers can implement targeted interventions and preventive measures, such as optimizing ventilation strategies and enhancing infection control practices. Future research should further explore additional factors that may influence the occurrence of VAP and verify these findings to provide stronger evidence for the prevention and treatment of VAP. Additionally, multicenter studies with larger sample sizes are recommended to validate these results and develop comprehensive guidelines for managing the chest trauma patients in the ICU.
METHODS: A retrospective analysis was conducted on the clinical data of 124 adult trauma patients admitted to the surgical ICU of Peking University People' s Hospital between June 2019 and June 2023. These patients underwent tra-cheal intubation within 24 hours of admission and received mechanical ventilation for more than 48 hours. Based on whether VAP occurred during hospitalization, the patients were divided into a VAP group (46 cases) and a non-VAP group (78 cases). Lasso regression analysis was employed for variable selection, followed by Logistic regression analysis to determine the risk factors for VAP in these patients with chest trauma in the ICU.
RESULTS: The multivariate regression analysis indicated that the injury severity score (ISS) (OR=1.08, 95%CI: 1.02-1.14, P=0.007) and tracheostomy (OR=4.61, 95%CI: 1.74-13.11, P=0.003) were independent risk factors for VAP in the patients with chest trauma (P < 0.05). Among all VAP cases, early-onset VAP was observed in 19 patients, while late-onset VAP was observed in 27 patients. The most common pathogen in all VAP cases was Klebsiella pneumoniae, identified in 18 cases (39.1%). In early-onset VAP, Klebsiella pneumoniae was the most frequently detected pathogen, found in 10 cases (52.6%). Conversely, in late-onset VAP, Pseudomonas aeruginosa and Acinetobacter baumannii were the most prevalent pathogens, each appearing in 10 cases (37.0%).
CONCLUSION: The occurrence of VAP in the patients with chest trauma in the ICU was influenced by multiple factors. This study identified that a higher ISS and the presence of a tracheostomy were independent risk factors for VAP in these patients. These findings suggest that in clinical practice, special attention should be given to the chest trauma patients with high ISS scores, and the timing and necessity of tracheostomy should be carefully considered to reduce the incidence of VAP and improve patient outcomes. Furthermore, the study highlights the importance of early identification and appropriate management of the patients at higher risk for developing VAP. By recognizing the significance of these risk factors, healthcare providers can implement targeted interventions and preventive measures, such as optimizing ventilation strategies and enhancing infection control practices. Future research should further explore additional factors that may influence the occurrence of VAP and verify these findings to provide stronger evidence for the prevention and treatment of VAP. Additionally, multicenter studies with larger sample sizes are recommended to validate these results and develop comprehensive guidelines for managing the chest trauma patients in the ICU.