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Weigeldt M, Schulz-Drost S, Stengel D, Lefering R, Treskatsch S, Berger C. In-hospital mortality after prehospital endotracheal intubation versus alternative methods of airway management in trauma patients. A cohort study from the TraumaRegister DGU®. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02498-8. [PMID: 38509186 DOI: 10.1007/s00068-024-02498-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Prehospital airway management in trauma is a key component of care and is associated with particular risks. Endotracheal intubation (ETI) is the gold standard, while extraglottic airway devices (EGAs) are recommended alternatives. There is limited evidence comparing their effectiveness. In this retrospective analysis from the TraumaRegister DGU®, we compared ETI with EGA in prehospital airway management regarding in-hospital mortality in patients with trauma. METHODS We included cases only from German hospitals with a minimum Abbreviated Injury Scale score ≥ 2 and age ≥ 16 years. All patients without prehospital airway protection were excluded. We performed a multivariate logistic regression to adjust with the outcome measure of hospital mortality. RESULTS We included n = 10,408 cases of whom 92.5% received ETI and 7.5% EGA. The mean injury severity score was higher in the ETI group (28.8 ± 14.2) than in the EGA group (26.3 ± 14.2), and in-hospital mortality was comparable: ETI 33.0%; EGA 30.7% (27.5 to 33.9). After conducting logistic regression, the odds ratio for mortality in the ETI group was 1.091 (0.87 to 1.37). The standardized mortality ratio was 1.04 (1.01 to 1.07) in the ETI group and 1.1 (1.02 to 1.26) in the EGA group. CONCLUSIONS There was no significant difference in mortality rates between the use of ETI or EGA, or the ratio of expected versus observed mortality when using ETI.
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Affiliation(s)
- Moritz Weigeldt
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | | | - Dirk Stengel
- BG Kliniken - Hospital Group of the German Federal Statutory Accident Insurance, Leipziger Platz 1, 10117, Berlin, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, 51109, Cologne, Germany
- Committee On Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU), Berlin, Germany
| | - Sascha Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Berger
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
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Ventilator Associated Pneumonia and Intubation Location in Adults with Traumatic Injuries: Systematic Review and Meta-analysis. J Trauma Acute Care Surg 2022; 93:e130-e138. [PMID: 35789149 DOI: 10.1097/ta.0000000000003737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ventilator associated pneumonia (VAP) is an important cause of morbidity and mortality among critically ill patients, particularly those who present with traumatic injuries. This review aims to determine whether patients with traumatic injuries who are intubated in the prehospital setting are at higher risk of developing VAP compared to those intubated in the hospital. METHODS A systematic review of Medline, Scopus and Cochrane electronic databases was conducted from inception through January 2021. Inclusion criteria were patients with traumatic injuries who were intubated in the prehospital or hospital settings with VAP as an outcome. Using a random effects model, the risk of VAP across study arms was compared by calculating a summary relative risk (RR) with 95% confidence intervals (CI). The results of individual studies were also summarized qualitatively. RESULTS The search identified 754 articles of which 6 studies (N = 2990) met inclusion criteria. All studies were good quality based on assessment with the Newcastle Ottawa scale. Prehospital intubation demonstrated an increased risk of VAP development in 2 of the 6 studies. Among the 6 studies, the overall quality weighted risk ratio was 1.09 (95% CI 0.90-1.31). CONCLUSIONS Traumatically injured patients who are intubated in the prehospital setting have a similar risk of developing VAP compared to those that are intubated in the hospital setting. LEVEL OF EVIDENCE Level IV systematic review and meta-analysis.
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Hirst C, Needham M. Risk factors and outcomes associated with ventilator associated pneumonia amongst intubated trauma patients admitted to the general intensive care unit of a major trauma centre. TRAUMA-ENGLAND 2022. [DOI: 10.1177/14604086221094651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Despite the use of care bundles, ventilator associated pneumonia (VAP) remains a frequently occurring health care-associated infection, increasing costs, length of stay (LOS) and mortality. The incidence is higher amongst trauma patients, although due to variable definitions and study populations risk factors for developing VAP are disputed, with few reports from the UK. Methods This 6-year review of intubated trauma patients admitted to the general Intensive Care Unit (ICU) of a UK major trauma centre, collected data on suspected risk factors for VAP, as well as demographic information, outcomes and microbiology. Ninety-nine patients who developed VAP within the first 7 days of admission were compared with 191 patient who did not, with multivariable logistic regression used to control for confounding variables. Results Univariable analysis suggested that injury severity score (ISS) (34 v 29), head injury (66.7% v 50.8%), polytrauma (79.8% v 68.1%) and ventilator days (10 v 5) were associated with increased risk of VAP, but after adjustment only ventilator days remained significant (OR 1.04, 95% CI 1.01–1.06). Antibiotics within 24 h of admission were associated with reduced odds of developing VAP, whether this was for pulmonary prophylaxis (OR 0.43, 95% CI 0.22–0.83, p = 0.013) or non-pulmonary reasons (OR 0.27, 95% CI 0.15–0.51, p < 0.001). Conclusions Only increasing ventilator days was associated with increased odds of developing VAP. The use of early antimicrobials was associated strongly with a reduction in the odds of developing VAP; this could be explained by unmeasured confounding or a prophylactic effect against aspiration.
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Affiliation(s)
- Claire Hirst
- Department of Critical Care, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Matthew Needham
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Lyng JW, Baldino KT, Braude D, Fritz C, March JA, Peterson TD, Yee A. Prehospital Supraglottic Airways: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:32-41. [PMID: 35001830 DOI: 10.1080/10903127.2021.1983680] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Supraglottic airway (SGA) devices provide effective conduits for oxygenation and ventilation and may offer protection from gastric aspiration. SGA devices are widely used by EMS clinicians as both rescue and primary airway management devices. While in common use for more than four decades, major developments in SGA education, science, and technology have influenced clinical strategies of SGA insertion and use in prehospital airway management for patients of all ages. NAEMSP recommends:SGAs have utility as a primary or secondary EMS airway intervention. EMS agencies should select SGA strategies that best suit available resources and local clinician skillset, as well as the nature of their clinical practice setting.EMS agencies that perform endotracheal intubation must also equip their clinicians with SGA devices and ensure adequate training and competence.In select situations, drug-assisted airway management may be used by properly credentialed EMS clinicians to facilitate SGA insertion.Confirmation of initial and continuous SGA placement using waveform capnography is strongly encouraged as a best practice.When it is functioning properly, EMS clinicians should refrain from converting an SGA to an endotracheal tube. The decision to convert an SGA to an endotracheal tube must consider the patient's condition, the effectiveness of SGA ventilations, and the clinical context and course of initial SGA insertionSGA training, competency, and clinical use must be continuously evaluated by EMS agencies using focused quality management programs.
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Prolonged Prehospital Time is a Risk Factor for Pneumonia in Trauma (the PRE-TRIP study): A Retrospective Analysis of the United States National Trauma Data Bank. Chest 2021; 161:85-96. [PMID: 34186039 DOI: 10.1016/j.chest.2021.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/19/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although multiple risk factors for development of pneumonia in patients with trauma sustained in a motor vehicle accident have been studied, the effect of prehospital time on pneumonia incidence post-trauma is unknown. RESEARCH QUESTION Is prolonged prehospital time an independent risk factor for pneumonia? STUDY DESIGN AND METHODS We retrospectively analyzed prospectively collected clinical data from 806,012 motor vehicle accident trauma incidents from the roughly 750 trauma hospitals contributing data to the National Trauma Data Bank between 2010 and 2016. RESULTS Prehospital time was independently associated with development of pneumonia post-motor vehicle trauma (p < 0.001). This association was primarily driven by patients with low Glasgow Coma Scale scores. Post-trauma pneumonia was uncommon (1.5% incidence) but was associated with a significant increase in mortality (p < 0.001, 4.3% mortality without pneumonia vs. 12.1% mortality with pneumonia). Other pneumonia risk factors included age, sex, race, primary payor, trauma center teaching status, bed size, geographic region, intoxication, comorbid lung disease, steroid use, lower Glasgow Coma Scale score, higher Injury Severity Scale score, blood product transfusion, chest trauma, and respiratory burns. INTERPRETATION Increased prehospital time is an independent risk factor for development of pneumonia and increased mortality in patients with trauma caused by a motor vehicle accident. Although prehospital time is often not modifiable, its recognition as a pneumonia risk factor is important as prolonged prehospital time may need to be considered in subsequent decision making. CLINICAL TRIAL REGISTRATION Not applicable.
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Prospective evaluation of airway management in pediatric out-of-hospital cardiac arrest. Resuscitation 2020; 156:53-60. [DOI: 10.1016/j.resuscitation.2020.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 11/22/2022]
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Keneally RJ, Peterson TJ, Benjamin JR, Hawkins K, Davison D. Making Ventilator Associated Pneumonia Rate a Meaningful Quality Marker. J Intensive Care Med 2020; 36:1354-1360. [PMID: 32885716 DOI: 10.1177/0885066620952763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Ventilator associated pneumonia (VAP) rate has been tracked as a comparable quality measure but there is significant variation between types of ICUs. We sought to understand variability and improve its utility as a marker of quality. METHODS The National Trauma Database was surveyed to identify risk factors for VAP. Logistic regression, χ2, Student's T-test or Mann-Whitney U test were used. RESULTS Risk factors associated with developing VAP were: injury severity score (ISS) (OR 1.03, 95% CI 1.03 -1.04), prehospital assisted respiration (PHAR) (OR 1.10, 1.03 -1.17), thoracic injuries (OR 2.28, 1.69-3.08), diabetes (OR 1.32, 1.20 -1.46), male gender (OR 1.38, 1.28 -1.60), care at a teaching hospital (OR 1.40, 1.29 -1.47) and unplanned intubation (OR 2.76, 2.52-3.03). DISCUSSION ISS, PHAR, diabetes, male gender, care at a teaching hospital and unplanned intubation are risk factors for the development of VAP. These factors should be accounted for in order to make VAP an effective quality marker.
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Affiliation(s)
- Ryan J Keneally
- Associate Professor of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Thomas J Peterson
- Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - John R Benjamin
- Assistant Professor of Anesthesiology and Critical Care Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Katrina Hawkins
- Associate Professor of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC, USA
| | - Danielle Davison
- Associate Professor of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC, USA
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Braude D, Dixon D, Torres M, Martinez JP, O'Brien S, Bajema T. Brief Research Report: Prehospital Rapid Sequence Airway. PREHOSP EMERG CARE 2020; 25:583-587. [PMID: 32628568 DOI: 10.1080/10903127.2020.1792015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Rapid Sequence Airway (RSA) describes the administration of an induction agent and paralytic followed by the intended primary placement of an extraglottic airway device rather than an endotracheal tube. The purpose of this study was to determine the success rates for prehospital RSA. The secondary goal was to determine aspiration rates among patients managed with RSA. METHODS Adult and pediatric prehospital RSA cases between 2005 and 2017 reported to an airway quality assurance registry from one ground and one air agency were reviewed. Success was defined as the ability to adequately ventilate patients after extraglottic device placement. Aspiration was defined as radiologic evidence (chest x-ray or CT scan) within 48 hours of hospital presentation. RESULTS 68 patients underwent RSA with a King LTS-D (n = 24), LMA-Supreme (n = 28), Combitube (n = 2), LMA-Unique (n = 8) and iGel (n = 6). Age ranged from 1 year to 73 years with 10 patients less than 18. RSA was successful in 64 (94%) cases; 56 (88%) were successful on first pass and 63 (98%) within 2 attempts. The RSA procedure occurred in an aircraft in 14 (21%) of cases and 71% of patients were in cervical precautions. Duration of EGD insertion prior to hospital arrival ranged from 5 to 102 minutes with an average of 34.5 minutes. Aspiration data was available for 46 patients of whom 4 (8.7%) were found to have evidence of aspiration. CONCLUSION Overall and first pass RSA success rates were high and aspiration rates were low in this quality assurance registry despite predictors of airway difficulty. RSA may be a reasonable alternative to RSI for prehospital airway management that merits further research.
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Braude D, Steuerwald M, Wray T, Galgon R. Managing the Out-of-Hospital Extraglottic Airway Device. Ann Emerg Med 2019; 74:416-422. [PMID: 31060744 DOI: 10.1016/j.annemergmed.2019.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Darren Braude
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM; Department of Anesthesiology, University of New Mexico Health Sciences Center, Albuquerque, NM.
| | | | - Trent Wray
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM; Division of Adult Critical Care, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Richard Galgon
- Department of Anesthesiology, University of Wisconsin, Madison, WI
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Wutzler S, Bläsius FM, Störmann P, Lustenberger T, Frink M, Maegele M, Weuster M, Bayer J, Caspers M, Seekamp A, Marzi I, Andruszkow H, Hildebrand F. Pneumonia in severely injured patients with thoracic trauma: results of a retrospective observational multi-centre study. Scand J Trauma Resusc Emerg Med 2019; 27:31. [PMID: 30871601 PMCID: PMC6419484 DOI: 10.1186/s13049-019-0608-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/28/2019] [Indexed: 01/03/2023] Open
Abstract
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 (AISthorax), 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.
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Affiliation(s)
- Sebastian Wutzler
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany
| | - Felix M Bläsius
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany.
| | - Philipp Störmann
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany
| | - Thomas Lustenberger
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany
| | - Michael Frink
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Marburg, Baldingerstraße, D-35043, Marburg, Germany
| | - Marc Maegele
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim, Medical Centre (CMMC), Ostmerheimer Str. 200, D-51109, Köln, Germany
| | - Matthias Weuster
- Department of Trauma Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Jörg Bayer
- Department of Orthopaedics and Trauma Surgery, Medical Centre Albert-Ludwings-University of Freiburg, Sir-Hans-A.-Krebs-Straße, D-79106, Freiburg, Germany
| | - Michael Caspers
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim, Medical Centre (CMMC), Ostmerheimer Str. 200, D-51109, Köln, Germany
| | - Andreas Seekamp
- Department of Trauma Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany
| | - Hagen Andruszkow
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany
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Steuerwald MT, Braude DA, Petersen TR, Peterson K, Torres MA. Preliminary Report: Comparing Aspiration Rates between Prehospital Patients Managed with Extraglottic Airway Devices and Endotracheal Intubation. Air Med J 2018; 37:240-243. [PMID: 29935702 DOI: 10.1016/j.amj.2018.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/10/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION There has been a shift from endotracheal intubation (ETI) toward extraglottic devices (EGDs) for prehospital airway management. A concern exists that this may lead to more frequent cases of aspiration. METHODS This was a retrospective study using a prehospital quality assurance database. Patients were assigned to groups based on the method that ultimately managed their airways (EGD or ETI). Cases with documented blood/emesis obscuring the airway were considered inevitable aspiration cases and excluded. Aspiration was defined by the radiology report within 48 hours. RESULTS A total of 104 EGD and 152 ETI patients were identified. Aspiration data were available for 67 EGD and 94 ETI cases. Of those, 8 EGD and 3 ETI cases had blood/emesis obscuring the airway and were excluded as planned. After exclusions, there were 5 EGD and 11 ETI cases in which aspiration was later diagnosed (EGD aspiration rate = 8%, ETI aspiration rate = 12%; χ2: P = .359; relative risk = .841; 95% confidence interval, .329-2.152). CONCLUSION In this small quality assurance database, aspiration rates were not significantly different for prehospital patients managed with an EGD versus ETI.
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Affiliation(s)
- Michael T Steuerwald
- UW Med Flight, 600 Highland Ave, Madison, WI 53792; Department of Emergency Medicine, University of Wisconsin-Madison, 800 University Bay Drive, Suite 310, Mail Code 9123, Madison, WI 53705.
| | - Darren A Braude
- Lifeguard Air Emergency Services, 2505 Clark Carr Loop SE, Albuquerque, NM 87106; Department of Emergency Medicine, University of New Mexico, MSC11 6025, Albuquerque, NM 87131; Department of Anesthesiology, University of New Mexico, MSC 10 6000, 2211 Lomas Blvd NE, Albuquerque, NM 87106
| | - Timothy R Petersen
- Department of Anesthesiology, University of New Mexico, MSC 10 6000, 2211 Lomas Blvd NE, Albuquerque, NM 87106
| | - Kari Peterson
- Treasure Valley EMS, 6116 Graye Ln, Caldwell, ID 83607; Payette County Paramedics, 200 S Whitley Dr, Fruitland, ID 83619; Vituity Idaho, 999 N Curtis Rd, Ste 407, Boise, ID 83706
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Michetti CP, Prentice HA, Rodriguez J, Newcomb A. Supine position and nonmodifiable risk factors for ventilator-associated pneumonia in trauma patients. Am J Surg 2017; 213:405-412. [DOI: 10.1016/j.amjsurg.2016.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/05/2016] [Accepted: 05/31/2016] [Indexed: 11/30/2022]
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