Clinical SurgerySupine position and nonmodifiable risk factors for ventilator-associated pneumonia in trauma patients

•Factors precluding continuous semiupright positioning in intubated trauma patients include acute spinal fracture, spinal cord injury, an open abdomen, and need for spine surgery.•A composite of these 4 factors was not found to increase the risk of ventilator-associated pneumonia.•The association of supine and semiupright position with VAP in trauma patients is discussed.•Early red cell or plasma transfusion, prehospital use of endotracheal obturator airway, head/neck Abbreviated Injury Score >2, and longer ventilator time increased VAP risk.

BackgroundWe studied trauma-specific conditions precluding semiupright positioning and other nonmodifiable risk factors for their influence on ventilator-associated pneumonia (VAP).MethodsWe performed a retrospective study at a Level I trauma center from 2008 to 2012 on ICU patients aged ≥15, who were intubated for more than 2 days. Using backward logistic regression, a composite of 4 factors (open abdomen, acute spinal cord injury, spine fracture, spine surgery) that preclude semiupright positioning (supine composite) and other variables were analyzed.ResultsIn total, 77 of 374 (21%) patients had VAP. Abbreviated Injury Score head/neck greater than 2 (odds ratio [OR] 2.79, P = .006), esophageal obturator airway (OR 4.25, P = .015), red cell/plasma transfusion in the first 2 intensive care unit days (OR 2.59, P = .003), and 11 or more ventilator days (OR 17.38, P < .0001) were significant VAP risk factors, whereas supine composite, scene vs emergency department airway intervention, brain injury, and coma were not.ConclusionFactors that may temporarily preclude semiupright positioning in intubated trauma patients were not associated with a higher risk for VAP.