The influence of enteral feeding on ventilator associated pneumonia (VAP) in trauma mechanically ventilated patients in ICU

Introduction

Enteral feeding is a well known risk factor for developing ventilated associated pneumonia (VAP) [1,2]. In this study we compared the incidence of VAP in trauma and non-trauma patients. Both groups were mechanically ventilated and enterally fed, in a 12 bed adult medical surgical ICU in a tertiary/ trauma center in Riyadh, Saudi Arabia.

Methods

A prospective study, all patients intubated and ventilated for more than 48 hours receiving enteral feeding by oral or nasal gastric tube were included during a period of 1 year. Diagnosis of VAP was made according to CDC criteria (Atlanta).

Results

The total number of patients included in this study was 141. Sixty-one (61) patients (43.3%) were trauma ventilated patients, and the remaining 80 patients (57.7%) were non-trauma ventilated patients. The VAP rate among the trauma patients was 45.9% compared to 26.3% in the non-trauma patients. The difference was significant (RR = 2.5, 95% CI = 1.1-5.2, P = 0.024). The table below compares trauma and non trauma patients who had enteral feeding with respect to APACHE, H₂ antagonist, sedation, and gastric tubes days. The APACHE score was the only variable significantly higher among non-trauma patients than trauma patients (19.3 vs 11.6, P < 0.001).

Table 1

Conclusion

In this study we showed that enteral feeding could be a risk factor for developing VAP in trauma patients in spite of being less critically ill than other medical or surgical (non-trauma) patients in ICU. However further studies are needed to elaborate more in the mechanism of VAP in trauma patients.