Younan Duraid, Delozier Sarah J, McQuay Nathaniel, Adamski John, Violette Aisha, Loudon Andrew, Ustin Jeffrey, Berg Regan, Tinkoff Glen, Moorman Matthew L, Research Consortium Uhrises
Department of Surgery, Division of Acute Care Surgery, University Hospitals Cleveland, 11100 Euclid Avenue, 3700 Bolwell, Cleveland, OH 44106, USA.
Center for Clinical Research, University Hospitals Cleveland, Cleveland, OH 44106, USA.
Healthcare (Basel). 2019 Apr 30;7(2):67. doi: 10.3390/healthcare7020067.
Ventilator-associated pneumonia is associated with significant morbidity. Although the association of gender with outcomes in trauma patients has been debated for years, recently, certain authors have demonstrated a difference. We sought to compare the outcomes of younger men and women to older men and women, among critically ill trauma patients with ventilator-associated pneumonia (VAP).
We reviewed our trauma data base for trauma patients with ventilator-associated pneumonia admitted to our trauma intensive care unit between January 2016 and June 2018. Data collected included demographics, injury mechanism and severity (ISS), admission vital signs and laboratory data and outcome measures including hospital length of stay, ICU stay and survival. Patients were also divided into younger (<50) and older (≥50) to account for hormonal status. Linear regression and binary logistic regression models were performed to compare younger men to older men and younger women to older women, and to examine the association between gender and hospital length of stay (LOS), ICU stay (ICUS), and survival.
Forty-five trauma patients admitted to our trauma intensive care unit during the study period (January 2016 to August 2018) had ventilator-associated pneumonia. The average age was 58.9 ± 19.6 years with mean ISS of 18.2 ± 9.8. There were 32 (71.1%) men, 27 (60.0%) White, and 41 (91.1%) had blunt trauma. Mean ICU stay was 14.9 ± 11.4 days and mean total hospital length of stay (LOS) was 21.5 ± 14.6 days. Younger men with VAP had longer hospital LOS 28.6 ± 17.1 days compared to older men 16.7 ± 6.6 days, ( < 0.001) and longer intensive care unit stay 21.6 ± 15.6 days compared to older men 11.9 ± 7.3 days ( = 0.02), there was no significant difference in injury severity (ISS was 22.2 ± 8.4 vs. 17 ± 8, = 0.09).
Among trauma patients with VAP, younger men had longer hospital length of stay and a trend towards longer ICU stay. Further research should focus on the mechanisms behind this difference in outcome using a larger database.
呼吸机相关性肺炎与显著的发病率相关。尽管性别与创伤患者预后的关联多年来一直存在争议，但最近，一些作者已经证明了两者存在差异。我们试图比较患有呼吸机相关性肺炎（VAP）的重症创伤患者中年轻男性与老年男性、年轻女性与老年女性的预后情况。
我们回顾了2016年1月至2018年6月期间入住我们创伤重症监护病房的患有呼吸机相关性肺炎的创伤患者的数据库。收集的数据包括人口统计学资料、损伤机制和严重程度（损伤严重度评分）、入院生命体征和实验室数据以及包括住院时间、重症监护病房停留时间和生存率在内的预后指标。患者还被分为年轻（<50岁）和年长（≥50岁）两组，以考虑激素状态。进行线性回归和二元逻辑回归模型，以比较年轻男性与老年男性、年轻女性与老年女性，并检验性别与住院时间（LOS）、重症监护病房停留时间（ICUS）和生存率之间的关联。
在研究期间（2016年1月至2018年8月），45名入住我们创伤重症监护病房的创伤患者患有呼吸机相关性肺炎。平均年龄为58.9±19.6岁，平均损伤严重度评分为18.2±9.8。有32名（71.1%）男性，27名（60.0%）白人，41名（91.1%）有钝性创伤。平均重症监护病房停留时间为14.9±11.4天，平均总住院时间（LOS）为21.5±14.6天。患有VAP的年轻男性的住院时间为28.6±17.1天，比老年男性的16.7±6.6天更长（<0.001），重症监护病房停留时间为21.6±15.6天，比老年男性的11.9±7.3天更长（=0.02），损伤严重程度无显著差异（损伤严重度评分为22.2±8.4对17±8，=0.09）。
在患有VAP的创伤患者中，年轻男性的住院时间更长，且有重症监护病房停留时间更长的趋势。应使用更大的数据库，进一步研究这种预后差异背后的机制。
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