Risk factors for ventilator-associated pneumonia in trauma patients with torso injury: a retrospective single-center study

Objective

We aimed to identify the risk factors for ventilator-associated pneumonia in patients admitted to critical care after a torso injury.

Methods

We retrospectively evaluated 178 patients with torso injury aged >15 years who were intubated in the emergency room and placed on a mechanical ventilator after intensive care unit (ICU) admission, survived for >48 hours, had thoracic and/or abdominal injuries, and had no end-stage renal disease. We compared clinico-laboratory variables between ventilator-associated pneumonia (n = 54, 30.3%) and non-ventilator-associated pneumonia (n = 124, 69.7%) groups. Risk factors for ventilator-associated pneumonia were assessed using multivariable logistic regression analysis.

Results

Ventilator-associated pneumonia was associated with a significantly longer stay in the ICU (11.3 vs. 6.8 days) and longer duration of mechanical ventilation (7 vs. 3 days). Injury Severity Score (adjusted odds ratio [AOR]: 1.048; 95% confidence interval [CI]: 1.008–1.090), use of vasopressors (AOR: 2.541; 95% CI: 1.121–5.758), and insertion of a nasogastric tube (AOR: 6.749; 95% CI: 2.397–18.999) were identified as independent risk factors of ventilator-associated pneumonia.

Conclusion

Ventilator-associated pneumonia in patients with torso injury who were admitted to the ICU was highly correlated with Injury Severity Score, use of vasopressors, and insertion of a nasogastric tube.

Incidence, causes and factors associated with torso injury in Cameroon: A community-based study

Background

Morbidity and mortality linked to injury has become an increasingly important public health concern worldwide, especially in developing countries. Despite the potentially severe nature of torso injury, little is known about the population-based epidemiology of torso injury in sub-Saharan Africa.

Objectives

To determine the incidence, identify common mechanisms, and assess the socioeconomic consequences of torso injury in Cameroon.

Methods

We performed a torso injury sub-analysis of a larger descriptive cross-sectional community-based study on injury epidemiology in the preceding 12 months in the Southwest region of Cameroon. Sampling was done using the three-stage cluster sampling technique. The differences between groups were evaluated using χ² and adjusted Wald tests.

Results

We identified 39 cases of torso injuries out of 8 065 participants, providing a yearly incidence estimate of 488 (95% confidence interval (CI) 356 - 668) per 100 000 person-years. Road traffic injury was the most common mechanism of torso injury. The median (interquartile range (IQR)) cost of treatment for torso injury was USD58 (10 - 137), over four times the median (IQR) cost for non-torso injury at USD12 (3 - 43) (p=0.0004). About half of affected households (51%) reported being unable to afford necessities such as rent and food after injury v. 33% of households with members with non-torso injuries (p=0.018).

Conclusion

Torso injuries have an incidence of 488/100 000 person-years, and road traffic injuries account for the majority of the injuries. Road traffic control measures and trauma care strengthening may reduce the impact of torso injuries and injuries in Cameroon.

Risk factors for acute kidney injury in critically ill patients with torso injury: A retrospective observational single-center study

Acute kidney injury (AKI) is common in trauma patients and associated with poor outcomes. Identifying AKI risk factors in trauma patients is important for risk stratification and provision of optimal intensive care unit (ICU) treatment. This study identified AKI risk factors in patients admitted to critical care after sustaining torso injuries.We performed a retrospective chart review involving 380 patients who sustained torso injuries from January 2016 to December 2019. Patients were included if they were aged >15 years, admitted to an ICU, survived for >48 hours, and had thoracic and/or abdominal injuries and no end-stage renal disease. AKI was defined according to the Kidney Disease Improving Global Outcomes definition and staging system. Clinical and laboratory variables were compared between the AKI and non-AKI groups (n = 72 and 308, respectively). AKI risk factors were assessed using multivariate logistic regression analysis.AKI occurred in 72 (18.9%) patients and was associated with higher mortality than non-AKI patients (26% vs 4%, P < .001). Multivariate logistic regression analysis identified bowel injury, cumulative fluid balance >2.5 L for 24 hours, lactate levels, and vasopressor use (adjusted odds ratio: 2.953, 2.058, 1.170, and 2.910; 95% confidence interval: 1.410-6.181, 1.017-4.164, 1.019-1.343, and 1.414-5.987; P = .004, .045, .026, and .004, respectively) as independent risk factors for AKI.AKI in patients admitted to the ICU with torso injury had a substantial mortality. Recognizing risk factors at an early stage could aid risk stratification and provision of optimal ICU care.