Predictors of ventilator-associated pneumonia in intubated pediatric trauma patients

Purpose: Ventilator-associated pneumonia (VAP) is the most common complication among intubated pediatric trauma patients (PTPs) in pediatric intensive care units. Early identification of associated risk factors may help mitigate adverse outcomes linked to VAP, such as increased mortality and healthcare costs. This study aims to identify risk factors associated with VAP for intubated PTPs. Methods: The 2017–2021 Trauma Quality Improvement Program database was queried for all intubated PTPs. Two groups were compared: intubated PTPs with and without VAP. Bivariate and multivariable logistic regression analyses were performed. Results: From 38,593 intubated PTPs, 819 (2.1%) developed VAP. The VAP cohort had a higher injury severity score with increased rates of traumatic brain injury (TBI) (75.3% vs. 55.4%, p < 0.001), rib fractures (24.0% vs. 16.4%, p < 0.001), and lung injuries (20.8% vs. 10.6%, p < 0.001). Independent associated risk factors for VAP included unplanned reintubation (OR 2.51, CI 1.84–3.43, p < 0.001), TBI (OR 1.96, CI 1.63–2.36, p < 0.001), and severe thoracic injury (OR 1.27, CI 1.01–1.58, p < 0.001). Conclusion: Unplanned reintubation, TBI, and severe thoracic injuries are key risk factors for VAP in intubated PTPs. Our findings highlight the need for strategies to reduce reintubation, optimize ventilator management, and improve pulmonary care in high-risk PTPs. Level of evidence: IV.