Abstract
Background: Ventilator-associated pneumonia is associated with significant morbidity. Although the association of gender with outcomes in trauma patients has been debated for years, recently, certain authors have demonstrated a difference. We sought to compare the outcomes of younger men and women to older men and women, among critically ill trauma patients with ventilator-associated pneumonia (VAP). Methods: We reviewed our trauma data base for trauma patients with ventilator-associated pneumonia admitted to our trauma intensive care unit between January 2016 and June 2018. Data collected included demographics, injury mechanism and severity (ISS), admission vital signs and laboratory data and outcome measures including hospital length of stay, ICU stay and survival. Patients were also divided into younger (<50) and older (≥50) to account for hormonal status. Linear regression and binary logistic regression models were performed to compare younger men to older men and younger women to older women, and to examine the association between gender and hospital length of stay (LOS), ICU stay (ICUS), and survival. Results: Forty-five trauma patients admitted to our trauma intensive care unit during the study period (January 2016 to August 2018) had ventilator-associated pneumonia. The average age was 58.9 ± 19.6 years with mean ISS of 18.2 ± 9.8. There were 32 (71.1%) men, 27 (60.0%) White, and 41 (91.1%) had blunt trauma. Mean ICU stay was 14.9 ± 11.4 days and mean total hospital length of stay (LOS) was 21.5 ± 14.6 days. Younger men with VAP had longer hospital LOS 28.6 ± 17.1 days compared to older men 16.7 ± 6.6 days, (p < 0.001) and longer intensive care unit stay 21.6 ± 15.6 days compared to older men 11.9 ± 7.3 days (p = 0.02), there was no significant difference in injury severity (ISS was 22.2 ± 8.4 vs. 17 ± 8, p = 0.09). Conclusions: Among trauma patients with VAP, younger men had longer hospital length of stay and a trend towards longer ICU stay. Further research should focus on the mechanisms behind this difference in outcome using a larger database.
Highlights
Trauma remains the leading cause of death in the United States among individuals aged 1 to 46 years [1]
Multiple authors have found ventilator-associated pneumonias to be a major cause of morbidity and mortality in different patient populations [4,5,6]; it is associated with prolonged hospital and intensive care unit lengths of stay, days on mechanical ventilation and an attributable mortality of approximately 13% [7]
Sex hormones have been found to be associated with outcomes before; after burn injury: estrogen is known to have an inhibitory role on the inflammatory response [8] and antecedent ovariectomy was found to improve survival [9] researchers have not agreed on the gender-associated difference in outcome in trauma patients [10,11]
Summary
Trauma remains the leading cause of death in the United States among individuals aged 1 to 46 years [1]. Trauma and injury result in a systemic body response characterized by acute nonspecific immune response that can be associated with weakened immunity and decreased resistance to infection. Multiple authors have found ventilator-associated pneumonias to be a major cause of morbidity and mortality in different patient populations [4,5,6]; it is associated with prolonged hospital and intensive care unit lengths of stay, days on mechanical ventilation and an attributable mortality of approximately 13% [7]. We sought to compare the outcomes of younger men and women to older men and women, among critically ill trauma patients with ventilator-associated pneumonia (VAP). Results: Forty-five trauma patients admitted to our trauma intensive care unit during the study period
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