Date of Award
Management Practice in Nurse Anesthesia
Type of Degree
Alberto Coustasse, Committee Chair, Graduate College of Business, Marshall University
Cassy Taylor, Committee Member, CAMC School of Nurse Anesthesia
Donna Slayton, Committee Member, CAMC Hospital, Staff Anesthesiologist
Introduction: Ventilator-Associated Pneumonia (VAP) continues to be a common complication among the adult trauma population. Little advancements have been made to decrease the incidence, suggesting further research is needed to establish modifiable risk factors. The purpose of this study was to test for an associated link between prehospital intubation and the development of VAP in the adult trauma patient.
Methodology: A retrospective, case-control study design was utilized. The sample included 494 adult trauma patients who required endotracheal intubation and mechanical ventilation for a minimum of 24 hours. All patients presented as a priority one or two trauma to the Charleston Area Medical Center (CAMC) between January 1, 2005 and May 1, 2012. The sample was divided into two groups: VAP group (n = 247) and No-VAP group (n = 247). Patient demographics (age, gender, body mass index), Injury Severity Score (ISS), Glasgow Coma Score (GCS), location of first intubation, length of time on ventilator, Intensive Care Unit (ICU) and hospital Length Of Stay (LOS) were gathered. The hypothesis was tested using logistic regression. Additional regression analysis and correlation studies assessed for additional risk factors for the development of VAP. Linear regressions analyzed for factors associated with an increased ICU LOS and hospital LOS.
Results: Trauma patients who were first intubated in the prehospital setting were 1.6 times more likely to develop VAP than those intubated by anesthesia upon arrival to or during their stay at the trauma center. Of those intubated by anesthesia, ICU and floor intubations were 3.2 times more likely to develop VAP compared to others intubated within the trauma center. Patients experiencing first intubation by anesthesia personnel upon arrival to Emergency Department (ED) were 2.5 times less likely to develop VAP than those intubated either in the prehospital setting or by anesthesia personnel in the operating room or after admission to the medical unit or ICU. Increased ventilator time and ICU LOS were found to have a statistically significant correlation to VAP. The presence of VAP, lower systolic blood pressure in ED, higher ISS, increased length of time on the ventilator, and intubation in the ICU or medical floor were significantly associated with the ICU length of stay. Higher ISS, presence of VAP, time on the ventilator, and ICU length of stay were associated with length of hospital stay.
Discussion: Prehospital intubation was associated with a significantly increased risk of developing VAP and those trauma patients who were first intubated in the prehospital setting were 1.6 times more likely to develop VAP than those who were intubated by anesthesia personnel after arrival to the trauma center. Additionally, patients who required emergent intubation after admission to the ICU or medical floor were 3.2 times more likely to develop VAP than any other patient who experienced the first intubation by anesthesia within the trauma center. Situational Airway management providers must be aware of this increased risk and practice techniques to minimize the risk of aspiration or tracheal contamination during intubation. Additionally, this study represented an area where there were not standardized Rapid Sequence Induction (RSI) protocols in place in the prehospital setting therefore standardization of prehospital RSI protocols should be initiated with follow-up prospective studies testing these benefits.
Conclusion: The high correlation between prehospital intubation and ventilator-associated pneumonia demonstrated in this study suggests that prehospital care may influence subsequent development of VAP.
Anesthesiology -- Research.
Nursing -- Research.
Chapman, Summer L., "Risk Factors for Ventilator-Associated Pneumonia in the Adult Trauma Patient: A Retrospective Case-Control Study From a Level I Trauma Center" (2012). Theses, Dissertations and Capstones. 1061.