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Journal of Trauma and Injury 2013;26(4):291-296.
Clinical Analysis of Ventilator-associated Pneumonia (VAP) in Blunt-chest-trauma Patients
Joong Hwan Oh, Il Hwan Park, Chun Sung Byun, Geum Suk Bae
1Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea. mdjhoh@yonsei.ac.kr
2Department of General Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.
흉부둔상환자에서 인공호흡기 관련 폐렴환자의 임상적 분석
오중환, 박일환, 변천성, 배금석1
연세대학교 원주의과대학 흉부외과학교실, 1일반외과학교
Received: 31 May 2013   • Revised: 2 October 2013   • Accepted: 17 October 2013
Abstract
PURPOSE
Prolonged ventilation leads to a higher incidence of ventilator-associated pneumonia (VAP), resulting in weaning failure and increased medical costs. The aim of this study was to analyze clinical results and prognostic factors of VAP in patients with blunt chest trauma.
METHODS
From 2007 to 2011, one hundred patients undergoing mechanical ventilation for more than 48 hours were divided into two groups: a VAP-negative group, (32 patients, mean age; 53 years, M:F=25:7) and a VAP-positive group, (68 patients, mean age; 60 years, M:F=56:12). VAP was diagnosed using clinical symptoms, radiologic findings and microorganisms. The injury severity score (ISS), shock, combined injuries, computerized tomographic pulmonary findings, transfusion, chronic obstructive lung disease (COPD), ventilation time, stay in intensive care unit (ICU) and hospital stays, complications such as sepsis or disseminated intravascular coagulation (DIC) and microorganisms were analyzed. Chi square, t-test, Mann-Whitney U test and logistic regression analysies were used with SPSS 18 software.
RESULTS
Age, sex, ISS, shock and combined injuries showed no differences between the VAP - negative group and - positive group (p>0.05), but ventilation time, ICU and hospital stays, blood transfusion and complications such as sepsis or DIC showed significant differencies (p<0.05). Four patients(13%) showed no clinical symptoms eventhough blood cultures were positive. Regardless of VAP, mortality-related factors were shock (p=0.036), transfusion (p=0.042), COPD (p=0.029), mechanical ventilation time (p=0.011), ICU stay (p=0.032), and sepsis (p=0.000). Microorgnisms were MRSA(43%), pseudomonas(24%), acinetobacter(16%), streptococcus(9%), klebsiela(4%), staphillococus aureus(4%). However there was no difference in mortality between the two groups.
CONCLUSION
VAP itself was not related with mortality. Consideration of mortality-related factors for VAP and its aggressive treatment play important roles in improving patient outcomes.
Key Words: Blunt chest trauma; Pulmonary contusion; Ventilator associated pneumonia; Intensive care unit


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