Beyond the Ventilator: Risk Factors for "Trauma-Associated" Pneumonia in the Trauma Intensive Care Unit

Ventilator-associated pneumonia (VAP) is a common intensive care unit (ICU) complication and a quality metric. Trauma patients may be uniquely predisposed to pulmonary infection from mechanisms intrinsic to injury (blunt chest trauma and pulmonary contusions) rather than ventilator exposure alone. This study hypothesized that trauma-specific factors would be associated with pneumonia in intubated trauma ICU patients.

A review of patients admitted to the trauma ICU at a level I trauma center with ≥2 ventilator days from 2018 to 2022 was performed. Patients were stratified into VAP and non-VAP groups. Logistic regression models were used to analyze risk factors for VAP.

During the 5-y study period, 444 patients met the inclusion criteria with 61 (13.7%) developing VAP. The VAP group had more blunt injury (98% versus 79%, P = 0.004), pulmonary contusions (ctx) (59% versus 35%, P < 0.001), ventilator (vent) days (12 versus 6 d, P < 0.001), and tracheostomies performed (53% versus 30%, P < 0.001). On logistic regression analysis, blunt injury (odds ratio [OR] 16.3), pulmonary ctx (OR 2.3), and vent days (OR 1.1) were associated with VAP in a multivariable model.

Blunt injury and pulmonary ctx were associated with increased odds of VAP, while longer vent days only slightly associated. With unique predisposition, many trauma ICU pulmonary infections are likely not "ventilator-associated" and may require a new diagnosis, definition, and predicted incidence of these "trauma-associated" pneumonias.