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The influence of enteral feeding on ventilator associated pneumonia (VAP) in trauma mechanically ventilated patients in ICU

Introduction

Enteral feeding is a well known risk factor for developing ventilated associated pneumonia (VAP) [1,2]. In this study we compared the incidence of VAP in trauma and non-trauma patients. Both groups were mechanically ventilated and enterally fed, in a 12 bed adult medical surgical ICU in a tertiary/ trauma center in Riyadh, Saudi Arabia.

Methods

A prospective study, all patients intubated and ventilated for more than 48 hours receiving enteral feeding by oral or nasal gastric tube were included during a period of 1 year. Diagnosis of VAP was made according to CDC criteria (Atlanta).

Results

The total number of patients included in this study was 141. Sixty-one (61) patients (43.3%) were trauma ventilated patients, and the remaining 80 patients (57.7%) were non-trauma ventilated patients. The VAP rate among the trauma patients was 45.9% compared to 26.3% in the non-trauma patients. The difference was significant (RR = 2.5, 95% CI = 1.1-5.2, P = 0.024). The table below compares trauma and non trauma patients who had enteral feeding with respect to APACHE, H2 antagonist, sedation, and gastric tubes days. The APACHE score was the only variable significantly higher among non-trauma patients than trauma patients (19.3 vs 11.6, P < 0.001).

Table 1

Conclusion

In this study we showed that enteral feeding could be a risk factor for developing VAP in trauma patients in spite of being less critically ill than other medical or surgical (non-trauma) patients in ICU. However further studies are needed to elaborate more in the mechanism of VAP in trauma patients.

References

  1. 1.

    Pingleton SK, et al.: Enteral nutrition as a risk factor for nosocomial pneumonia. Eur J Clin Micro Inf Dis 1989, 8: 551-555.

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  2. 2.

    Memish Z, et al.: The incidence and risk factors of VAP in a Riyadh hospital. Inf Cont Hosp Epid 2000, 21: 271-273.

    CAS  Article  Google Scholar 

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Djazmati, W., Memish, Z., Oni, G. et al. The influence of enteral feeding on ventilator associated pneumonia (VAP) in trauma mechanically ventilated patients in ICU. Crit Care 5, P038 (2001). https://doi.org/10.1186/cc1106

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Keywords

  • Public Health
  • Pneumonia
  • Emergency Medicine
  • Trauma Patient
  • Trauma Center