Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany.
Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany.
Scand J Trauma Resusc Emerg Med. 2019 Mar 14;27(1):31. doi: 10.1186/s13049-019-0608-4.
BACKGROUND: While the incidence and aspects of pneumonia in ICU patients has been extensively discussed in the literature, studies on the occurrence of pneumonia in severely injured patients are rare. The aim of the present study is to elucidate factors associated with the occurrence of pneumonia in severely injured patients with thoracic trauma. SETTING: Level-I University Trauma Centres associated with the TraumaRegister DGU®. METHODS: A total of 1162 severely injured adult patients with thoracic trauma documented in the TraumaRegister DGU® (TR-DGU) were included in this study. Demographic data, injury severity, duration of mechanical ventilation (MV), duration of ICU stay, occurrence of pneumonia, bronchoalveolar lavage, aspiration, pathogen details, and incidences of mortality were evaluated. Statistical evaluation was performed using SPSS (Version 25.0, SPSS, Inc.) software. RESULTS: The overall incidence of pneumonia was 27.5%. Compared to patients without pneumonia, patients with pneumonia had sustained more severe injuries (mean ISS: 32.6 vs. 25.4), were older (mean age: 51.3 vs. 47.5) and spent longer periods under MV (mean: 368.9 h vs. 114.9 h). Age, sex (male), aspiration, and duration of MV were all independent predictors for pneumonia occurrence in a multivariate analysis. The cut-off point for duration of MV that best discriminated between patients who would and would not develop pneumonia during their hospital stay was 102 h. The extent of thoracic trauma (AIS), ISS, and presence of pulmonary comorbidities did not show significant associations to pneumonia incidence in our multivariate analysis. No significant difference in mortality between patients with and without pneumonia was observed. CONCLUSIONS: Likelihood of pneumonia increases with age, aspiration, and duration of MV. These parameters were not found to be associated with differences in outcomes between patients with and without pneumonia. Future studies should focus on independent parameters to more clearly identify severely injured subgroups with a high risk of developing pneumonia. LEVEL OF EVIDENCE: Level II - Retrospective medical record review.
背景：尽管 ICU 患者肺炎的发病率和方面在文献中已有广泛讨论，但关于严重创伤患者肺炎发生的研究却很少。本研究旨在阐明与胸部创伤严重损伤患者肺炎发生相关的因素。
设置：与创伤登记处 DGU®（TR-DGU）相关的一级大学创伤中心。
方法：本研究共纳入 1162 例胸部创伤严重损伤的成年患者，这些患者均记录在创伤登记处 DGU®（TR-DGU）中。评估人口统计学数据、损伤严重程度、机械通气（MV）时间、重症监护病房（ICU）停留时间、肺炎发生情况、支气管肺泡灌洗、误吸、病原体详细信息和死亡率。统计评估使用 SPSS（版本 25.0，SPSS 公司）软件进行。
结果：肺炎总发生率为 27.5%。与无肺炎的患者相比，有肺炎的患者的损伤更为严重（ISS 平均值：32.6 比 25.4），年龄更大（平均年龄：51.3 比 47.5），MV 时间更长（平均：368.9 小时比 114.9 小时）。多变量分析显示，年龄、性别（男性）、误吸和 MV 时间是肺炎发生的独立预测因素。最佳区分住院期间是否发生肺炎的 MV 时间截断值为 102 小时。在多变量分析中，胸部创伤（AIS）程度、ISS 和肺部合并症的存在与肺炎发生率无显著关联。有肺炎和无肺炎的患者之间的死亡率无显著差异。
结论：肺炎的发生几率随着年龄、误吸和 MV 时间的增加而增加。这些参数与有肺炎和无肺炎患者之间的结局差异无关。未来的研究应侧重于独立参数，以更清楚地识别发生肺炎风险较高的严重损伤亚组。
证据水平：二级-回顾性病历回顾。
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