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J Trauma Inj > Epub ahead of print |
Ethical statements
The study was approved by the Institutional Review Board of the Cheju Halla General Hospital (No. 2021-L06-01). Informed consent was waived due to the retrospective nature of the study.
Author contributions
Conceptualization: TYL, JWO, MKL, JSK, JES; Data curation: TYL, JWO, JES, SHJ; Formal analysis: MKL, JSK, SHJ; Methodology: TYL, JWO, MKL, JES; Project administration: TYL, JWO; Visualization: JSK, SHJ; Writing–original draft: TYL, JWO, MKL, JSK, JES, JHW; Writing–review&editing: TYL, JWO, MKL, JSK, JES, JHW.
All authors read and approved the final manuscript.
Highlights the stepwise respiratory deterioration associated with VAC, IVAC, possible pneumonia, and probable pneumonia with specific, objective criteria that define each category. Sputum cultures excludes the following: normal respiratory/oral flora, mixed respiratory/oral flora or equivalent; Candida species or yeast not otherwise specified; coagulase-negative Staphylococcus species; and Enterococcus species.
NHSN, National Healthcare Safety Network; VAE, ventilator-associated event; VAC, ventilator-associated condition; IVAC, infection-related ventilator-associated complication; PEEP, positive end-expiratory pressure; FIO2, fraction of inspired oxygen; VAP, ventilator-associated pneumonia; BAL, bronchoalveolar lavage; CFU, colony-forming unit.
Adapted from Spalding et al. [13] with permission from Elsevier.
Variable | No VAE (n=48) | VAE (n=25) | P-value |
---|---|---|---|
Age (yr) | 57.6±19.1 | 64.4±16.5 | 0.138 |
Sex | |||
Male | 62.5 | 80.0 | 0.207 |
Female | 37.5 | 20.0 | |
Comorbidity | |||
Hypertension | 37.5 | 40.0 | >0.999 |
Diabetes mellitus | 8.3 | 20.0 | 0.287 |
Chronic kidney disease | 0 | 8.0 | 0.218 |
Cerebrovascular attack | 10.4 | 12.0 | >0.999 |
Tumor | 0 | 8.0 | 0.218 |
Liver disease | 6.2 | 0 | 0.512 |
Mechanism of injury | |||
Traffic accident | 43.8 | 56.0 | 0.455 |
Fall from height | 20.8 | 12.0 | 0.539 |
Slip down | 14.6 | 16.0 | >0.999 |
Struck by object | 6.2 | 12.0 | 0.689 |
Glasgow Coma Scale score | 9.2±4.1 | 11.8±4.1 | 0.012* |
Injury Severity Score | 25.8±10.2 | 23.2±11.2 | 0.813 |
Abbreviated Injury Scale | |||
Head | 3.35±1.92 | 2.86±2.00 | 0.327 |
Face | 0.41±0.90 | 0.45±1.01 | 0.858 |
Chest | 1.43±1.60 | 2.36±1.53 | 0.024* |
Abdomen | 0.92±1.34 | 0.68±1.17 | 0.469 |
Extremity | 0.86±1.34 | 1.27±1.12 | 0.214 |
External | 0.67±0.89 | 0.59±0.59 | 0.715 |
Variable | No VAE (n=48) | VAE (n=25) | P-value |
---|---|---|---|
Clinical values | |||
SBP (mmHg) | 130±51 | 134±47 | 0.760 |
DBP (mmHg) | 77±29 | 79±27 | 0.843 |
Pulse rate (/min) | 86±29 | 89±31 | 0.631 |
Respiratory rate (/min) | 22±7 | 22±4 | 0.947 |
Body temperature (℃) | 36.3±0.8 | 36.4±0.5 | 0.291 |
Blood cell count | |||
WBC (×1,000 cells/mm3) | 13.4±5.4 | 12.2±6.2 | 0.421 |
Hemoglobin (g/dL) | 12.5±2.3 | 12.6±1.9 | 0.845 |
Hematocrit (%) | 36.3±6.7 | 37.1±5.3 | 0.606 |
Platelet (×1,000/μL) | 228±91 | 214±73 | 0.512 |
Chemistry | |||
BUN (mg/dL) | 19±15 | 22±15 | 0.422 |
Creatinine (mg/dL) | 0.9±0.5 | 1.7±2.4 | 0.125 |
GFR (mL/min/1.73 m2) | 98.5±46.5 | 68.4±27.8 | 0.001** |
CRP (mg/dL) | 1.9±7.3 | 0.6±2.1 | 0.264 |
CPK (U/L) | 366±331 | 441±482 | 0.508 |
ABGA | |||
pH | 7.3±0.1 | 7.4±0.1 | 0.512 |
PaCO2 (mmHg) | 35.8±8.1 | 33.9±6.5 | 0.334 |
PaO2 (mmHg) | 165.7±69.9 | 137.6±58.1 | 0.094 |
Saturation (%) | 97.6±4.3 | 97.4±3.3 | 0.836 |
Lactate (mg/dL) | 35.5±22.0 | 49.5±33.7 | 0.508 |
Values are presented as mean±standard deviation. P-value obtained using Student t-tests for continuous variables.
VAE, ventilator-associated event; SBP, systolic blood pressure; DBP, diastolic blood pressure; WBC, white blood cell; BUN, blood urea nitrogen; GFR, glomerular filtration rate; CRP, C-reactive protein; CPK, creatine phosphokinase; ABGA, arterial blood gas analysis.
Variable | No VAE (n=48) | VAE (n=25) | P-value |
---|---|---|---|
MV day | 17.7±15.4 | 25.2±23.9 | 0.164 |
Length of stay | |||
ICU in day | 26.3±22.0 | 33.7±25.7 | 0.200 |
Hospital in day | 86.8±69.9 | 61.0±33.9 | 0.037* |
Bronchoscopy | 3.9± 4.7 | 14.1±15.9 | 0.004** |
Complication | |||
AKI | 4 (8.3) | 3 (12.0) | 0.931 |
ARDS | 0 | 4 (16.0) | 0.021* |
CPR | 4 (8.3) | 4 (16.0) | 0.548 |
VTE | 7 (14.6) | 4 (16.0) | 1.000 |
PTE | 8 (16.7) | 5 (20.0) | 0.975 |
UTI | 3 (6.2) | 1 (4.0) | 1.000 |
CRBSI | 1 (2.1) | 1 (4.0) | 1.000 |
Unplanned intubation | 6 (12.5) | 7 (28.0) | 0.187 |
Unplanned operation | 6 (12.5) | 4 (16.0) | 0.957 |
Unplanned ICU transfer | 5 (10.4) | 6 (24.0) | 0.232 |
In-hospital mortality | 11 (22.9) | 11 (44.0) | 0.111 |
Values are presented as mean±standard deviation or number (%). P-value obtained using chi square test and student t-tests for categorical and continuous variables, respectively.
VAE, ventilator-associated event; MV, mechanical ventilator; ICU, intensive care unit; AKI, acute kidney injury; ARDS, acute respiratory distress syndrome; CPR, cardiopulmonary resuscitation; VTE, venous thromboembolism; PTE, pulmonary thromboembolism; UTI, urinary tract infection; CRBSI, catheter-related blood stream infection.
Variable |
VAE occurrence |
In-hospital mortality |
||
---|---|---|---|---|
OR (95% CI) | P-value | OR (95% CI) | P-value | |
Male sex | 2.25 (0.66–8.81) | 0.2102 | 0.54 (0.15–1.90) | 0.3357 |
Age ≥65 years | 0.95 (0.25–3.32) | 0.9365 | 2.14 (0.67–7.33) | 0.2167 |
Injury Severity Score ≥15 | 0.30 (0.05–1.73) | 0.1841 | 1.96 (0.34–12.4) | 0.4554 |
Abbreviated Injury Scale | ||||
Chest ≥3 | 4.73 (1.46–17.9) | 0.0135* | 0.48 (0.12–1.70) | 0.2662 |
Head ≥3 | 1.24 (0.31–5.61) | 0.7615 | 0.49 (0.12–2.04) | 0.3151 |
GFR <75 mL/min/1.73 m2 | 4.15 (1.32–14.1) | 0.0170* | 4.19 (1.30–14.3) | 0.0181* |
VAE (+) | 2.53 (0.67–10.1) | 0.1733 |
GFR <75 mL/min/1.73 m2 | GFR ≥75 mL/min/1.73 m2 | P-value | |
---|---|---|---|
Categorical values | |||
Male sex | 20 (27.4) | 30 (41.1) | 0.5993 |
Hypertension | 15 (20.5) | 13 (17.8) | 0.0388* |
Diabetes mellitus | 5 (6.8) | 4 (5.4) | 0.2765 |
Continuous values | |||
Age (yr) | 66.5±16.3 | 56.0±18.7 | 0.0153* |
ISS | 22.6±10.7 | 26.2±10.3 | 0.1648 |
ICU stay (day) | 35.1±29.0 | 25.2±18.9 | 0.1179 |
MVD | 26.7±25.4 | 16.5±12.8 | 0.0595† |
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