Lorena Ferreira Pilicie, Elaine Cristina Gonçalves, Viviany Mendes Borges, Marden Henrique Lima, Augusto Diogo Filho, Eliane Maria Carvalho


Introduction: The literature has been demonstrating that the incidence of Hospital-Acquired Pneumonia is higher in victims of trauma. The objective is to identify the risk factors for the development of Hospital-Acquired Pneumonia in polytrauma patients. Outline: Retrospective and longitudinal study, with analysis of 70 medical records of admitted patients in the emergency unit at a tertiary hospital, for a period longer than 48 hours. There were collected from medical records: admission data, data of the trauma, invasive methods and clinical indicators of pneumonia in the hospitalization. Results: From the 70 included patients, 15 (21,4%) showed pneumonia until the fifth hospitalization day. When applied the univariate logistic regression, it was observed that the Glasgow Coma Scale to the admission (p=0,03), use of endotracheal tube (p=0,01) and nasogastric tube (p=0,04) associated with the increasing of the risk of hospital-acquired pneumonia. Implications: the study demonstrated that level of consciousness, the use of endotracheal tube and the use of the nasogastric tube are predisposing factors for the development of hospital-acquired pneumonia in these patients, being the endotracheal intubation an independent risk factor.


Pneumonia; Ferimentos e Lesões; Fatores de Risco; Infecção Hospitalar.

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Cook A, Norwood S, Berne J. Ventilator-associated pneumonia is more common and of less consequence in trauma patients compared with other critically ill patients. J Trauma [Internet]. 2010 Nov [cited 24 Aug 2020]; 69(5):1083–91. Available from: http://doi.org/10.1097/TA.0b013e3181f9fb51

Masterton RG, Galloway A, French G, Street M, Armstrong J, Brown E, et al. Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the working party on hospital-acquired pneumonia of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother [Internet]. 2008 Jul [cited 24 Aug 2020]; 62(1):5–34. Available from: http://doi.org/10.1093/jac/dkn162

Kalanuria AA, Ziai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care [Internet]. 2014 Mar [cited 24 Aug 2020]; 18(2):208. Available from: http://doi.org/10.1186/cc13775

American Thoracic Society. Infectious Diseases Society of America: Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med [Internet]. 2005 Feb [cited 24 Aug 2020]; 171(4):388–416. Available from: http://doi.org/10.1164/rccm.200405-644ST

Glance LG, Stone PW, Mukamel DB, Dick AW. Increases in mortality, length of stay, and cost associated with hospital-acquired infections in trauma patients. Arch Surg [Internet]. 2011 Jul [cited 24 Aug 2020]; 146(7):794–801. Available from:


Mangram AJ, Sohn J, Zhou N, Hollingworth AK, Ali-Osman FR, Sucher JF, et al. Trauma-associated pneumonia: time to redefine ventilator-associated pneumonia in trauma patients. Am J Surg [ Internet]. 2015 Dec [cited 24 Aug 2020]; 210(6):1056–61. Available from: http://doi.org/10.1016/j.amjsurg.2015.06.029

Wallace WC, Cinat M, Gornick WB, Lekawa ME, Wilson SE. Nosocomial infections in the surgical intensive care unit: a difference between trauma and surgical patients. Am Surg [Internet]. 1999 Oct [cited 24 Aug 2020]; 65(10):987–90. Available from: http://www.ihi.org/resources/Pages/Publications/NosocomialInfectionsintheSurgicalIntensiveCareUnit.aspx

Eckert MJ, Davis KA, Reed 2nd RL, Santaniello JM, Poulakidas S, Esposito TJ, et al. Urgent airways after trauma: who gets pneumonia? J Trauma [Internet]. 2004 Oct [cited 24 Aug 2020]; 57(4):750–5. Available from: http://doi.org/10.1097/01.ta.0000147499.73570.12

Byun JH, Kim HY. Factors affecting pneumonia occurring to patients with multiple rib fractures. Korean J Thorac Cardiovasc Surg [Internet]. 2013 Apr [cited 24 Aug 2020]; 46(2):130–4. Available from: http://doi.org/10.5090/kjtcs.2013.46.2.130

Oyetunji TA, Jackson HT, Obirieze AC, Moore D, Branche MJ, Grene WR, et al. Associated injuries in traumatic sternal fractures: a review of the National Trauma Data Bank. Am Surg [Internet]. 2013 Jul [cited 24 Aug 2020]; 79(7):702–5. Available from:


Aukema TS, Beenen LFm, Hietbrink F, Leenen L. Validation of the Thorax Trauma Severity Score for mortality and its value for the development of acute respiratory distress syndrome. Open Access Emerg Med [Internet]. 2011 Aug [cited 24 Aug 2020]; 3:49–53. Available from: http://doi.org/10.2147/OAEM.S22802

Arumugam SK, Mudali I, Strandvik G, El-Menyar A, Al-Hassani A, Al-Thani H. Risk factors for ventilator-associated pneumonia in trauma patients: A descriptive analysis. World J Emerg Med [Internet]. 2018 Aug [cited 24 Aug 2020]; 9(3):203–210. Available from: http://doi.org/10.5847/wjem.j.1920-8642.2018.03.007

Swanson J, Wood GC, Croce MA, Mueller EW, Boucher BA, Fabian TC. Utility of preliminary bronchoalveolar lavage results in suspected ventilator-associated pneumonia. J Trauma [Internet]. 2008 Dec [cited 24 Aug 2020]; 65(6):1271–7. Available from: http://doi.org/10.1097/TA.0b013e3181574d6a

Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 17. Critical pathway for the treatment of established intracranial hypertension in pediatric traumatic brain injury. Pediatr Crit Care Med [Internet]. 2003 Sep [cited 24 Aug 2020]; 4(3 Suppl):65–7. Available from: https://pubmed.ncbi.nlm.nih.gov/12847353/

Michelet P, Couret D, Brégeon F, Perrin G, D’Journo X, Pequignot V, et al. Early onset pneumonia in severe chest trauma: a risk factor analysis. J Trauma [Internet]. 2010 Feb [cited 24 Aug 2020]; 68(2):395–400. Available from:


Civil ID, Schwab, CW. The Abbreviated Injury Scale, 1985 revision: a condensed chart for clinical use. J Trauma [Internet]. 1988 Jan [cited 24 Aug 2020]; 28(1):87–90. Available from: http://doi.org/10.1097/00005373-198801000-00012

Centers for Disease Control and Prevention. Ventilator-associated Pneumonia (VAP). Available from: https://www.cdc.gov/hai/vap/vap.html. Accessed on: 06 Aug 2020.

Hyllienmark P, Brattström O, Larsson E, Martling C-R, Petersson J,Oldner A. High incidence of post-injury pneumonia in intensive care-treated trauma patients. Acta Anaesthesiol Scand [Internet]. 2013 Aug [cited 24 Aug 2020]; 57(7):848–54. Available from: http://doi.org/10.1111/aas.12111

Pape H-C, Halvachizadeh S, Leenen L, Velmahos GD, Buckley R, Giannoudis PV. Timing of major fracture care in polytrauma patients - An update on principles, parameters and strategies for 2020. Injury [Internet]. 2019 Oct [cited 24 Aug 2020]; 50(10):1656–1670. Available from: http://doi.org/10.1016/j.injury.2019.09.021

Hu PJ, Pittet J-F, Kerby JD, Bosarge PL, Wagener BM. Acute brain trauma, lung injury, and pneumonia: more than just altered mental status and decreased airway protection. Am J Physiol Lung Cell Mol Physiol [Internet]. 2017 Jul [cited 24 Aug 2020]; 313(1):1–15. Available from: http://doi.org/10.1152/ajplung.00485.2016

Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol [Internet]. 2000 Aug [cited 24 Aug 2020]; 21(8):510–5. Available from:


Konrad F, Schreiber T, Brecht-Kraus D, Georgieff M. Mucociliary Transport in ICU Patients. Chest [Internet]. 1994 Aug [cited 24 Aug

; 105(1):237–241. Available from: http://doi.org/10.1378/chest.105.1.237

Pneumatikos IA, Dragoumanis CK, Bouros DE. Ventilator-associated pneumonia or endotracheal tube-associated pneumonia? An approach to the pathogenesis and preventive strategies emphasizing the importance of endotracheal tube. Anesthesiology [Internet]. 2009 Jan [cited 24 Aug 2020]; 110:673–680. Available from: http://doi.org/10.1097/ALN.0b013e31819868e0

Rosenthal VD, Maki DG, Mehta Y, Leblebicioglu H, Memish ZA, Al-Mousa HH, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module. Am J Infect Control [Internet]. 2014 Sep [cited 24 Aug 2020]; 42(9):942–56. Available from: http://doi.org/10.1016/j.ajic.2014.05.029

Villas Boas PJF, Ruiz T. [Occurrence of hospital infection among interned elderly in a university hospital]. Rev Saude Publica [Internet]. 2004 Jun [cited 24 Aug 2020]; 38(3):372–8. Available from: http://doi.org/10.1590/s0034-89102004000300006

Tejerina E, Esteban A, Fernándes-Segoviano P, Frutos-Vivar F, Aramburu j, Ballesteros D, et al. Accuracy of clinical definitions of ventilator-associated pneumonia: Comparison with autopsy findings. J Crit Care [Internet]. 2010 Mar [cited 24 Aug 2020]; 25(1):62–8. Available from: http://doi.org/10.1016/j.jcrc.2009.05.008

Mietto C, Pinciroli R, Patel N, Berra L. Ventilator associated pneumonia: evolving definitions and preventive strategies. Respir Care [Internet]. 2013 Jun [cited 24 Aug 2020]; 58(6):990–1007. Available from: http://doi.org/10.4187/respcare.02380

Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control [Internet]. 2008 Jun [cited 24 Aug 2020]; 36(5):309–32. Available from: http://doi.org/10.1016/j.ajic.2008.03.002

DOI: https://doi.org/10.26694/repis.v6i0.10548


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