Defining Pathogen and Susceptibility Patterns for Early Versus Late Ventilator Associated Pneumonia in Trauma Patients to Guide Empiric Treatment Decisions.

INTRODUCTION: Studies have demonstrated that trauma patients with early-ventilator associated pneumonia (early-VAP, < 7 days) have decreased risk of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa infections. We hypothesize that routinely using broad-spectrum antibiotics is unnecessary to treat trauma patients with the diagnosis of early-VAP. METHODS: This retrospective cohort study included adult trauma patients with the diagnosis of VAP. The primary outcome was the presence of MRSA and/or P. aeruginosa in patients with early- and late-VAP. Secondary outcomes included the bacterial susceptibility of pathogens to methicillin, ampicillin/sulbactam, ceftriaxone, piperacillin/tazobactam, and cefepime. Intensive care unit (ICU) and hospital length of stay (LOS), ventilator-free days, and in-hospital mortality were also collected. RESULTS: 164 patients met inclusion criteria, and 208 organisms (n = 90 early vs n = 118 late) were identified by respiratory culture. The incidence of MRSA and P. aeruginosa in early-VAP was 7.7% (7/90) and 5.6% (5/90), respectively. The susceptibility of bacteria causing early-VAP to ampicillin/sulbactam and ceftriaxone was 73.3% (66/90) and 83.3% (75/90), respectively. Ventilator-free days at 30 days was similar between groups (P = .649). Patients with late-VAP spent more time in the ICU (P = .040); however, in-hospital mortality was higher in the early-VAP group (P = .012). CONCLUSIONS: Ampicillin/sulbactam or ceftriaxone monotherapy did not provide reliable broad-spectrum coverage for early-VAP in our cohort. These findings highlight the importance of each institution performing a similar analysis to ensure adequate initial treatment of VAP.

Systematically Building a Model to Support and Unify Advanced Practice Providers.

Nursing leaders at the University of South Alabama (USA) Health collaborated to explore the need for a structured practice model for advanced practice providers (APP). The goal of this collaboration was to create an organizational structure where APPs could thrive clinically and professionally.

Elimination of Routine Benzodiazepine Administration for Nonprocedural Sedation in a Trauma Intensive Care Unit Is Feasible.

Current guidelines on the management of pain, agitation, and delirium in the intensive care unit (ICU) recommend a non-benzodiazepine (BDZ)-based approach to sedation. Management of agitation can be challenging in multitrauma patients but is imperative to facilitate patient recovery. Given the current guideline recommendations, a protocol to eliminate BDZ administration and maintain light levels of sedation was adopted in our ICU. The purpose of this analysis was to demonstrate that it is feasible to safely eliminate BDZ administration in a trauma ICU. This was a single-center, retrospective, observational analysis at a Level I trauma center. Adult patients (>18 years old) admitted to the Trauma Critical Care service from March 2015 to August 2015 were included. The primary outcome recorded was the use and duration of nonprocedural BDZs which was defined as BDZ not given within one hour of a procedure or test. A total of 64 patients met the inclusion criteria. The average Injury Severity Score was 18.7. A total of 14 patients (21.9%) received BDZ for a nonprocedure-related indication. Of those patients, all (100%) received less than three as-needed doses of BDZs during their ICU stay. In mechanically ventilated patients, continuous sedation or analgesia was not continued for more than 1.3 days. Only five patients (7.8%) received continuous BDZ. Limiting sedation is feasible in critically ill polytrauma patients. Protocols to standardize sedation strategies should be implemented in the ICU to avoid unnecessary sedation.