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Prehospital airway technique does not influence incidence of ventilator-associated pneumonia in trauma patients

Steuerwald, Michael Thomas MD; Robinson, Bryce R.H. MD, MS; Hanseman, Dennis J. PhD; Makley, Amy MD; Pritts, Timothy A. MD, PhD

Journal of Trauma and Acute Care Surgery: February 2016 - Volume 80 - Issue 2 - p 283–288
doi: 10.1097/TA.0000000000000886
Original Articles

BACKGROUND The relationship between the prehospital airway device used and later development of ventilator-associated pneumonia (VAP) is unknown. We sought to determine if the prehospital airway device choice is associated with an increased risk of VAP in risk-adjusted critically injured patients.

METHODS We performed a retrospective analysis of all trauma patients requiring definitive airway placement before intensive care unit admission at a Level I trauma center from 2008 to 2012. Prehospital airway management strategies were classified as extraglottic device placement, endotracheal intubation, bag-valve mask ventilation (BVM), or lack of a prehospital airway with subsequent intubation at the trauma center. Patients were excluded if they were hospital transfers, were dead on arrival, died in the emergency department, or did not require at least 48 hours of mechanical ventilation. The primary end point was the development of VAP as determined by institutional guidelines for diagnosis. Logistic regression was used to determine risk factors for VAP.

RESULTS A total of 317 patients met inclusion criteria. The median age was 37 years (interquartile range, 25–51 years), 75% were male, 78% sustained a blunt injury, and the median Injury Severity Score (ISS) was 29 (interquartile range, 21–34). Ninety-seven patients (30.6%) developed VAP. Prehospital airway strategies were as follows: 17 (5.4%) had extraglottic device placement, 28 (8.8%) had BVM, 84 (26.5%) had endotracheal intubation, and 188 (59.3%) had no prehospital airway placement and were intubated after arrival. The type of prehospital airway was not statistically significant in terms of VAP development (range, 26.1–42.9%; p = 0.15). The only statistically significant predictor of VAP was length of mechanical ventilation (univariate: odds ratio, 1.14; 95% confidence interval, 1.10–1.18; p ≤ 0.01; multivariate: odds ratio, 1.15; 95% confidence interval, 1.10–1.20; p ≤ 0.01).

CONCLUSION Our data suggest that the prehospital airway device used was not associated with the development of VAP.

LEVEL OF EVIDENCE Therapeutic study, level IV; epidemiologic study, level III.

From the Departments of Emergency Medicine (M.T.S.) and Surgery (B.R.H.R., D.J.H., A.M., T.A.P.) and the Institute for Military Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Submitted: February 5, 2015, Revised: August 11, 2015, Accepted: September 2, 2015, Published online: October 21, 2015.

This study was presented at the annual meeting of the Society for Academic Emergency Medicine, May 2014, Dallas, Texas.

Address for reprints: Timothy A. Pritts, MD, PhD, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, Ohio 45267-0558; email:

© 2016 Lippincott Williams & Wilkins, Inc.