Carr Brendan G, Kaye Adam J, Wiebe Douglas J, Gracias Vicente H, Schwab C William, Reilly Patrick M
Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA.
J Trauma. 2007 Jul;63(1):9-12. doi: 10.1097/TA.0b013e31805d8f6b.
Pneumonia occurs commonly in intubated patients and is morbid and occasionally mortal. Pneumonia prevention strategies have been successful in the intensive care unit and are favorably regarded, cost effective, and efficacious. Trauma patients are often intubated emergently in the prehospital or emergency department (ED) setting. Nationwide, hospital crowding has resulted in prolonged ED length of stay (LOS). We sought to study the association between prolonged ED LOS and rates of pneumonia.
This was a 2-year retrospective case-control study of pneumonia risk among blunt trauma patients presenting to an urban Level I trauma center who were emergently intubated. The trauma registry was queried for demographic and clinical information. All patients who were intubated prehospital or in the ED and developed pneumonia were identified as cases. A group of matched controls with equivalent age, injury severity score, abbreviated injury score (AIS) chest, and AIS head who did not develop pneumonia were identified. A comparison of ED LOS between the two groups was assessed using conditional logistic regression.
We identified 509 emergently intubated blunt trauma patients. Of these, 33 developed pneumonia and could be matched with comparable controls. The case subjects had a mean age of 44.6 (+/-24.3), a mean injury severity score of 32.7 (+/- 9.4), a mean chest AIS of 1.5 (+/-1.6), and a mean head AIS of 4.4 (+/-1.2). The ED LOS for the cases was significantly longer than that for the controls (281.3 minutes vs. 214.0 minutes, p < 0.05). Each hour increased the risk of developing pneumonia by approximately 20%.
In blunt trauma patients who are emergently intubated, increased ED LOS is an independent risk factor for pneumonia. Ventilator associated pneumonia interventions, successful in the intensive care unit, should be implemented early in the hospital course, and efforts should be made to minimize hospital crowding and ED LOS.
肺炎在插管患者中很常见，具有致病性，偶尔会导致死亡。肺炎预防策略在重症监护病房已取得成功，受到好评，具有成本效益且效果显著。创伤患者常在院前或急诊科（ED）紧急插管。在全国范围内，医院拥挤导致急诊科住院时间（LOS）延长。我们试图研究急诊科住院时间延长与肺炎发生率之间的关联。
这是一项为期2年的回顾性病例对照研究，研究对象为在城市一级创伤中心就诊并紧急插管的钝性创伤患者的肺炎风险。查询创伤登记处获取人口统计学和临床信息。所有在院前或急诊科插管并发生肺炎的患者被确定为病例。确定一组年龄、损伤严重程度评分、简略损伤评分（AIS）胸部和AIS头部相当且未发生肺炎的匹配对照。使用条件逻辑回归评估两组之间的急诊科住院时间差异。
我们确定了509例紧急插管的钝性创伤患者。其中，33例发生肺炎，并可与可比对照匹配。病例组的平均年龄为44.6（±24.3），平均损伤严重程度评分为32.7（±9.4），平均胸部AIS为1.5（±1.6），平均头部AIS为4.4（±1.2）。病例组的急诊科住院时间明显长于对照组（281.3分钟对214.0分钟，p<0.05）。每增加一小时，发生肺炎的风险增加约20%。
在紧急插管的钝性创伤患者中，急诊科住院时间延长是肺炎的独立危险因素。在重症监护病房成功实施的呼吸机相关性肺炎干预措施，应在医院病程早期实施，并应努力减少医院拥挤和急诊科住院时间。
