(1741) Evaluating Precipitating Factors for Ventilator-Associated Pneumonia in Trauma Patients

Introduction: Ventilator associated pneumonia (VAP) causes significant morbidity and mortality for trauma patients. We hypothesized that factors related to trauma injuries, medical history, hospital course, and airway management contribute to VAP. If identified, these precipitating factors could aid in targeting VAP prevention efforts.

Methods: Data was collected for adult trauma patients with ≥ 1 ventilator days from January 2022 – December 2023 from our institutional trauma registry and through retrospective chart review. We excluded patients that died < 48 hours after initiation of mechanical ventilation. Univariate analyses using t-test and chi-square test were performed on variables of interest comparing patients with and without VAP. The Liu method was used to maximize the product of sensitivity and specificity for select continuous variables in relationship to VAP. Significant variables (p < 0.05) were included in a multivariable logistic regression model to identify predictors of VAP.

Results: Of the 401 included patients, 35 (8.73%) were diagnosed with VAP. Demographic factors and comorbidities were similar between the groups. On univariate analysis, Injury Severity Score (ISS) of ≥ 15, chest tube duration ≥ 2.5 days, ventilator days ≥ 10.5, pulmonary contusion, rib fracture, sternal fracture, spinal injury, emergent intubation after admission, reintubation, sepsis, and intensive care unit (ICU) length of stay were significantly associated with VAP (p < 0.05). Prolonged chest tube duration (OR 2.45, [CI 1.01-5.90]) and rib fracture (OR 2.73, [CI 1.06-7.03]) were significant independent predictors of VAP.

Conclusions: After controlling for confounding factors, we identified potential precipitating factors for VAP in trauma patients including prolonged chest tube duration and rib fracture. These factors can be utilized to target a subset of high VAP-risk patients for performance improvement efforts in the ICU.