Study objective: To determine whether patient transport out of the ICU is associated with an increased risk of developing ventilator-associated pneumonia.
Design: Prospective cohort study.
Setting: ICUs of Barnes-Jewish Hospital, a university-affiliated teaching hospital.
Patients: Five hundred twenty-one ICU patients requiring mechanical ventilation for >12 h.
Intervention: Prospective patient surveillance and data collection.
Measurements and results: The primary outcome measure was the development of ventilator-associated pneumonia. A total of 273 (52.4%) mechanically ventilated patients required at least one transport out of the ICU while 248 (47.6%) patients did not undergo transport. Sixty-six (24.2%) of the transported patients developed ventilator-associated pneumonia compared with 11 (4.4%) patients in the group not undergoing transport (relative risk=5.5; 95% confidence interval [CI]=2.9 to 10.1; p<0.001). Multiple logistic regression analysis demonstrated that a preceding episode of transport out of the ICU was independently associated with the development of ventilator-associated pneumonia (adjusted odds ratio=3.8; 95% CI=2.6 to 5.5; p<0.001). Other variables independently associated with the development of ventilator-associated pneumonia included reintubation, presence of a tracheostomy, administration of aerosols, and male gender.
Conclusions: We conclude that patient transport out of the ICU is associated with an increased risk for the development of ventilator-associated pneumonia.