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Am. J. Respir. Crit. Care Med., Volume 159, Number 6, June 1999, 1742-1746

Risk Factors for Developing Pneumonia within 48 Hours of Intubation

JORDI RELLO, EMILI DIAZ, MARTA ROQUE, and JORDI VALLÉS

Pulmonary and Critical Care Departments, Hospital de Sabadell, and CEPSS/FPT, Sabadell, Barcelona, Spain

Two hundred fifty intubated patients were followed during the first 48 h after intubation in order to identify potential risk factors for developing pneumonia within this period. Thirty-two developed pneumonia during this time. Univariate analysis established that large volume aspiration, presence of sedation, intubation caused by respiratory/cardiac arrest or decrease in the level of consciousness, emergency procedure, cardiopulmonary resuscitation (CPR), and Glasgow coma score < 9 were significantly associated with pneumonia. In contrast, prior infection and prior antimicrobial use were associated with a protective effect. Presence of subglottic secretion drainage and 15 other variables had no significant effect. Multivariate analysis selected CPR (odds ratio [OR] = 5.13, 95% confidence intervals [CI] = 2.14, 12.26) and continuous sedation (OR = 4.40, 95% CI = 1.83, 10.59) as significant risk factors for pneumonia, while antibiotic use (OR = 0.29, 95% CI = 0.12, 0.69) showed a protective effect. Our findings emphasize that risk factors for pneumonia change during the intubation period, and preventing pneumonia requires a combined approach.




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