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Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients

BACKGROUND: Post-traumatic ventilator-associated pneumonia (VAP) is a substantial clinical problem that increases hospital costs and typically adds to the duration of mechanical ventilation. We evaluated the impact of VAP on ventilator days. We also assessed 48-hour total blood cholesterol (TC) and...

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Autores principales: Dunham, C Michael, Chirichella, Thomas J
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058028/
https://www.ncbi.nlm.nih.gov/pubmed/21371328
http://dx.doi.org/10.1186/1476-511X-10-42
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author Dunham, C Michael
Chirichella, Thomas J
author_facet Dunham, C Michael
Chirichella, Thomas J
author_sort Dunham, C Michael
collection PubMed
description BACKGROUND: Post-traumatic ventilator-associated pneumonia (VAP) is a substantial clinical problem that increases hospital costs and typically adds to the duration of mechanical ventilation. We evaluated the impact of VAP on ventilator days. We also assessed 48-hour total blood cholesterol (TC) and other potential risk factors for the development of VAP. METHODS: We performed a retrospective study of consecutive trauma patients requiring emergency tracheal intubation and evaluated TC, age, gender, ethanol status, smoker status, injury mechanism, chest injury, brain injury, Injury Severity Score (ISS), shock, day-one hypoxemia, and RBC transfusion as potential risks for VAP. RESULTS: The 152 patients had ISS 28.1, brain injury 68.4%, VAP 50.0%, ventilator days 14.3, and death 9.9%. Ventilator days were increased with late VAP (p < 0.0001). TC was 110.7 mg/dL with expected TC 197.5 mg/dL. TC was lower with chest injury, shock, and RBC transfusion but, higher with brain injury (p ≤ 0.01). TC decreased as ISS increased (p = 0.01). However, one patient subset (ISS ≥ 20-&-TC ≥ 90 mg/dL) had a relative increase in TC despite an increase in ISS. ISS ≥ 20-&-TC ≥ 90 mg/dL, but not ISS alone, was the only independent predictor of late VAP (OR 3.0; p = 0.002). ISS ≥ 20-&-TC ≥ 90 mg/dL and day-one hypoxemia were the only independent predictors for increased ventilator days (p = 0.01). ISS ≥ 20-&-TC ≥ 90 mg/dL, but not ISS alone, was the only predictor of death (OR 3.8; p = 0.03). CONCLUSIONS: Severe traumatic injury produced substantial hypocholesterolemia that is greater with chest injury, shock, and RBC transfusion, but less with brain injury. Total blood cholesterol tended to decrease with increasing injury severity. However, attenuated hypocholesterolemia (ISS ≥ 20-&-TC ≥ 90 mg/dL) represents a unique response that can occur with critical injury. Attenuated hypocholesterolemia signals early risk for late VAP, ventilator dependency, and death.
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spelling pubmed-30580282011-03-16 Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients Dunham, C Michael Chirichella, Thomas J Lipids Health Dis Research BACKGROUND: Post-traumatic ventilator-associated pneumonia (VAP) is a substantial clinical problem that increases hospital costs and typically adds to the duration of mechanical ventilation. We evaluated the impact of VAP on ventilator days. We also assessed 48-hour total blood cholesterol (TC) and other potential risk factors for the development of VAP. METHODS: We performed a retrospective study of consecutive trauma patients requiring emergency tracheal intubation and evaluated TC, age, gender, ethanol status, smoker status, injury mechanism, chest injury, brain injury, Injury Severity Score (ISS), shock, day-one hypoxemia, and RBC transfusion as potential risks for VAP. RESULTS: The 152 patients had ISS 28.1, brain injury 68.4%, VAP 50.0%, ventilator days 14.3, and death 9.9%. Ventilator days were increased with late VAP (p < 0.0001). TC was 110.7 mg/dL with expected TC 197.5 mg/dL. TC was lower with chest injury, shock, and RBC transfusion but, higher with brain injury (p ≤ 0.01). TC decreased as ISS increased (p = 0.01). However, one patient subset (ISS ≥ 20-&-TC ≥ 90 mg/dL) had a relative increase in TC despite an increase in ISS. ISS ≥ 20-&-TC ≥ 90 mg/dL, but not ISS alone, was the only independent predictor of late VAP (OR 3.0; p = 0.002). ISS ≥ 20-&-TC ≥ 90 mg/dL and day-one hypoxemia were the only independent predictors for increased ventilator days (p = 0.01). ISS ≥ 20-&-TC ≥ 90 mg/dL, but not ISS alone, was the only predictor of death (OR 3.8; p = 0.03). CONCLUSIONS: Severe traumatic injury produced substantial hypocholesterolemia that is greater with chest injury, shock, and RBC transfusion, but less with brain injury. Total blood cholesterol tended to decrease with increasing injury severity. However, attenuated hypocholesterolemia (ISS ≥ 20-&-TC ≥ 90 mg/dL) represents a unique response that can occur with critical injury. Attenuated hypocholesterolemia signals early risk for late VAP, ventilator dependency, and death. BioMed Central 2011-03-03 /pmc/articles/PMC3058028/ /pubmed/21371328 http://dx.doi.org/10.1186/1476-511X-10-42 Text en Copyright ©2011 Dunham and Chirichella; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Dunham, C Michael
Chirichella, Thomas J
Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients
title Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients
title_full Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients
title_fullStr Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients
title_full_unstemmed Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients
title_short Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients
title_sort attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058028/
https://www.ncbi.nlm.nih.gov/pubmed/21371328
http://dx.doi.org/10.1186/1476-511X-10-42
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