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首页> 外文期刊>Journal of burn care & research: official publication of the American Burn Association >Ventilator-associated pneumonia after combined burn and trauma is caused by associated injuries and not the burn wound.
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Ventilator-associated pneumonia after combined burn and trauma is caused by associated injuries and not the burn wound.

机译：合并烧伤和创伤后的呼吸机相关性肺炎是由相关的伤害而非烧伤引起的。

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摘要

An increased risk of ventilator-associated pneumonia (VAP) has previously been demonstrated in trauma patients urgently intubated in the prehospital (ie, field) and emergency department (ED) settings. This study investigated the impact of urgent intubation on subsequent VAP in patients who sustained both a burn injury and a traumatic injury. We undertook a retrospective review of both trauma registry data and medical records for all patients with combined thermal and traumatic injuries admitted to a single verified burn center and level I trauma center. Patients undergoing field or ED intubation during the 5-year period ending December 2002 were identified and studied. Data abstracted included admission demographics and vital signs, presence of inhalation injury, location at the time of intubation, presence of associated injury, percentage TBSA burn, hospital and intensive care unit length of stay, and hospital day of VAP diagnosis. Seventy-eight of the 3388 patients (2.3%) admitted during the study period sustained a combination of burn wounds and trauma and underwent urgent field or ED intubation. The majority of patients were men (71%), with a mean age of 46 +/- 24 years. There was one failed oral intubation, which required cricothyroidotomy. The location of the patient at the time of intubation was ED, 66%; burn center ED, 17%; and field, 17%. Eighty percent of all patients were diagnosed with an inhalation injury. VAP was diagnosed in 39 patients (50%), with a mean time to diagnosis of 10 +/- 9 days. TBSA burn, smoke inhalation, and time (in days) to diagnosis of VAP were not independent risk factors for the occurrence of pneumonia in any of the 3 groups. However, those intubated at the initial ED were more likely to develop VAP (P = .028) compared to those intubated in the field or in the burn center. The incidence of associated injuries was significantly greater (P < .0001) in the initial ED group. Only a small percentage of burn patients also sustain blunt trauma. VAP occurs in 50% of the patients requiring urgent intubation. Independent risk factors appear to be intubation at an initial ED before transfer and associated injuries.
机译：先前已在医院前（即现场）和急诊室（ED）的环境中紧急插管的创伤患者中证实了呼吸机相关性肺炎（VAP）的风险增加。这项研究调查了烧伤和外伤同时发生的患者紧急插管对随后VAP的影响。我们对所有入院并经过验证的烧伤中心和I级创伤中心合并热损伤和外伤的患者的创伤登记数据和病历进行了回顾性审查。确定并研究了在2002年12月结束的5年中接受野外或ED插管的患者。提取的数据包括入院人口统计学和生命体征，吸入性损伤的存在，插管时的位置，相关损伤的存在，TBSA烧伤百分比，住院和重症监护病房的住院时间以及VAP诊断的住院日。在研究期间入院的3388例患者中有78例（2.3％）持续合并烧伤和创伤，并接受了紧急手术或ED插管。大多数患者为男性（71％），平均年龄为46 +/- 24岁。一次经口插管失败，需要进行环甲切开术。插管时患者的位置为ED，占66％;烧伤中心ED，17％;田间，占17％。所有患者中有80％被诊断为吸入性损伤。在39例患者（50％）中诊断出VAP，平均诊断时间为10 +/- 9天。 TBSA烧伤，烟气吸入和诊断VAP的时间（以天为单位）不是3组中任何一组发生肺炎的独立危险因素。但是，与野外或烧伤中心插管的患者相比，初次ED插管的患者更有可能发生VAP（P = .028）。在最初的ED组中，相关伤害的发生率显着更高（P <.0001）。只有一小部分烧伤患者也遭受钝器创伤。 VAP发生在50％需要紧急插管的患者中。独立的危险因素似乎是在初次ED时插管，以及转移和相关伤害之前。

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