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Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (2): 351-358. doi: 10.19723/j.issn.1671-167X.2026.02.020

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Risk factors for ventilator-associated pneumonia in patients with chest trauma in intensive care unit

Jie ZHAO, Chun FU, Xiujuan ZHAO, Haiyan XUE, Shu LI, Zhenzhou WANG, Fengxue ZHU*()   

  1. Department of Critical Care Medicine, Trauma Treatment Center, Peking University People's Hospital, Beijing 100044, China
  • Received:2024-02-22 Online:2026-04-18 Published:2025-09-24
  • Contact: Fengxue ZHU
  • Supported by:
    the National Natural Science Foundation of China(81971808)

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Abstract:

Objective: To explore the risk factors associated with ventilator-associated pneumonia (VAP) in the patients with chest trauma in the intensive care unit (ICU). Methods: A retrospective analysis was conducted on the clinical data of 124 adult trauma patients admitted to the surgical ICU of Peking University People' s Hospital between June 2019 and June 2023. These patients underwent tra-cheal intubation within 24 hours of admission and received mechanical ventilation for more than 48 hours. Based on whether VAP occurred during hospitalization, the patients were divided into a VAP group (46 cases) and a non-VAP group (78 cases). Lasso regression analysis was employed for variable selection, followed by Logistic regression analysis to determine the risk factors for VAP in these patients with chest trauma in the ICU. Results: The multivariate regression analysis indicated that the injury severity score (ISS) (OR=1.08, 95%CI: 1.02-1.14, P=0.007) and tracheostomy (OR=4.61, 95%CI: 1.74-13.11, P=0.003) were independent risk factors for VAP in the patients with chest trauma (P < 0.05). Among all VAP cases, early-onset VAP was observed in 19 patients, while late-onset VAP was observed in 27 patients. The most common pathogen in all VAP cases was Klebsiella pneumoniae, identified in 18 cases (39.1%). In early-onset VAP, Klebsiella pneumoniae was the most frequently detected pathogen, found in 10 cases (52.6%). Conversely, in late-onset VAP, Pseudomonas aeruginosa and Acinetobacter baumannii were the most prevalent pathogens, each appearing in 10 cases (37.0%). Conclusion: The occurrence of VAP in the patients with chest trauma in the ICU was influenced by multiple factors. This study identified that a higher ISS and the presence of a tracheostomy were independent risk factors for VAP in these patients. These findings suggest that in clinical practice, special attention should be given to the chest trauma patients with high ISS scores, and the timing and necessity of tracheostomy should be carefully considered to reduce the incidence of VAP and improve patient outcomes. Furthermore, the study highlights the importance of early identification and appropriate management of the patients at higher risk for developing VAP. By recognizing the significance of these risk factors, healthcare providers can implement targeted interventions and preventive measures, such as optimizing ventilation strategies and enhancing infection control practices. Future research should further explore additional factors that may influence the occurrence of VAP and verify these findings to provide stronger evidence for the prevention and treatment of VAP. Additionally, multicenter studies with larger sample sizes are recommended to validate these results and develop comprehensive guidelines for managing the chest trauma patients in the ICU.

Key words: Ventilator-associated pneumonia, Thoracic injuries, Mechanical ventilation, Intensive care units, Risk factors

CLC Number: 

  • R563.1

Figure 1

Patients enrollment flowchart ICU, intensive care unit; VAP, ventilator-associated pneumonia."

Table 1

Baseline data of patients (n=124)"

Feature Non-VAP (n=78) VAP (n=46) P value
General information
  Age/years, M (P25, P75) 58 (46, 66) 54 (43, 64) 0.660
  Gender (male), n (%) 55 (70.5) 39 (84.8) 0.073
Medical history, n (%)
  Diabetes 7 (9.0) 5 (10.9) 0.760
  Hypertension 15 (19.2) 16 (34.8) 0.053
  Chronic kidney disease 1 (1.3) 1 (2.2) 0.999
  Hepatitis B 2 (2.6) 1 (2.2) 0.999
  Cerebrovascular disease 5 (6.4) 5 (10.9) 0.497
  Emphysema 5 (6.4) 1 (2.2) 0.411
  Coronary heart disease 1 (1.3) 3 (6.5) 0.144
  Smoking history 9 (11.5) 5 (10.9) 0.909
  Drinking history 6 (7.7) 4 (8.7) 0.999
Type of trauma, n (%) 0.854
  Traffic accident injury 50 (64.1) 32 (69.6)
  Fall injury 18 (23.1) 9 (19.6)
  Slip injury 6 (7.7) 2 (4.3)
  Crush injury 4 (5.1) 3 (6.5)
Overall trauma condition
  Shock, n (%) 26 (33.3) 20 (43.5) 0.259
  Head injury, n (%) 39 (50.0) 32 (69.6) 0.033
  Facial injury, n (%) 28 (35.9) 18 (39.1) 0.719
  Abdominal injury, n (%) 35 (44.9) 19 (41.3) 0.699
  Spinal injury, n (%) 32 (41.0) 23 (50.0) 0.331
  Pelvic injury, n (%) 38 (48.7) 25 (54.3) 0.545
  ISS score, M (P25, P75) 26 (19, 34) 29 (26, 34) 0.003
  GCS score, M (P25, P75) 14 (11, 15) 13 (7, 15) 0.022
Chest trauma condition
  Chest AIS score, ${\bar x}$±s 3.15±0.77 3.33±0.70 0.207
  Number of rib fractures, M (P25, P75) 5 (2, 10) 4 (2, 10) 0.801
  Clavicle fracture, n (%) 12 (15.4) 12 (26.1) 0.145
  Sternum fracture, n (%) 7 (9.0) 3 (6.5) 0.743
  Lung contusion, n (%) 53 (67.9) 33 (71.7) 0.658
  Pleural effusion, n (%) 49 (62.8) 31 (67.4) 0.607
  Pneumothorax, n (%) 29 (37.2) 20 (43.5) 0.488
Routine blood tests
  White blood cell count/(×109/L), M (P25, P75) 16.71 (12.58, 21.53) 18.41 (14.92, 22.57) 0.145
  Neutrophil percentage/%, M (P25, P75) 90.6 (88.6, 92.8) 90.2 (87.7, 92.1) 0.247
  Hemoglobin level/(g/L), ${\bar x}$±s 79.31±17.55 79.80±16.98 0.402
  Platelet count/(×109/L), M (P25, P75) 65 (47, 110) 75 (49, 120) 0.284
Blood product usage
  Red blood cells/U, M (P25, P75) 6 (1, 13) 8 (4, 14) 0.327
  Plasma/mL, M (P25, P75) 400 (0, 900) 400 (0, 1 050) 0.580
  Platelets/U, ${\bar x}$±s 0.51±1.36 0.43±0.91 0.703
Complications, n (%)
  VTE 4 (5.1) 2 (4.3) 0.999
  AKI 6 (7.7) 3 (6.5) 0.999
  ARDS 2 (2.6) 3 (6.5) 0.359
ICU procedures, n (%)
  CVC 48 (61.5) 30 (65.2) 0.682
  Thoracentesis 34 (43.6) 15 (32.6) 0.227
  Tracheostomy 8 (10.3) 18 (39.1) < 0.001
  Multiple intubations 2 (2.6) 4 (8.7) 0.193
Surgeries, n (%)
  Thoracic surgery 29 (37.2) 14 (30.4) 0.446
  Cranial surgery 13 (16.7) 8 (17.4) 0.917
  Pelvic surgery 17 (21.8) 12 (26.1) 0.585
  Spinal surgery 9 (11.5) 6 (13.0) 0.804
  Abdominal surgery 9 (11.5) 9 (19.6) 0.220
  Femoral surgery 11 (14.1) 4 (8.7) 0.372
Mechanical ventilation duration/h, ${\bar x}$±s 183±116 299±290 0.012
Outcomes
  ICU stay duration/d, ${\bar x}$±s 16±9 19±12 0.140
  Discharge outcome (mortality), n (%) 10 (12.8) 5 (10.9) 0.748

Table 2

Pathogen distribution in VAP patients"

Pathogen Total VAP patients (n=46), n (%) Early-onset VAP (n=19), n (%) Late-onset VAP (n=27), n (%)
Pseudomonas aeruginosa 12 (26.1) 2 (10.5) 10 (37.0)
Acinetobacter baumannii 13 (28.3) 3 (15.8) 10 (37.0)
Klebsiella pneumoniae 18 (39.1) 10 (52.6) 8 (29.6)
Stenotrophomonas maltophilia 7 (15.2) 0 (0) 7 (25.9)
Escherichia coli 2 (4.3) 2 (10.5) 0 (0)
Candida albicans 2 (4.3) 0 (0) 2 (7.4)
Enterobacter cloacae 2 (4.3) 0 (0) 2 (7.4)

Figure 2

Lasso regression coefficient penalty plot A, Lasso coefficient profiles plotted against the logeλ. The upper axis indicates the number of non-zero coefficients. B, ten-fold cross-validation for determining the optimal tuning parameter λ (λ_min and λ_1se) in the Lasso regression model."

Table 3

Multivariate analysis in the Logistic regression model"

Predictor Estimate SE Z P Odds ratio Lower Upper
(Intercept) -2.773 0.783 -3.543 0.000 0.062 0.012 0.268
ISS score 0.067 0.026 2.550 0.011 1.069 1.017 1.128
Tracheostomy 1.608 0.499 3.224 0.001 4.995 1.928 13.904
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