Table 2.
Relationship Between Pneumonia Prevention Practices and Odds of Postoperative Pneumonia
| Characteristic | All | Pneumonia | Odds Ratio (95% CI) | P-Value | |
|---|---|---|---|---|---|
| 100% (N=2,482) | No, 97.6% (n=2,422) | Yes, 2.4% (n=60) | |||
| Preoperative prophylaxis | |||||
| Oral Preparation | 63.82 | 63.79 | 65.00 | 1.00 (0.59–1.72) | 0.98 |
| Nasal Culture | 35.54 | 35.67 | 30.00 | 0.76 (0.44–1.34) | 0.35 |
| Nasal Antibiotic Prophylaxis | 64.34 | 64.45 | 60.00 | 0.86 (0.49–1.51) | 0.60 |
| Composite intervention: Preoperative nasal and oral prophylaxis | 45.33 | 45.50 | 38.33 | 0.73 (0.43–1.26) | 0.26 |
| Intraoperative ventilation | |||||
| Highest Tidal Volume, mL | 608.07 (188.57) | 607.68 (189.13) | 624.14 (164.35) | 1.00 (0.99–1.00) | 0.53 |
| Lung Protective Tidal Volume (< 8 mL/Kg) | 0.78 | 0.75 | 1.69 | 2.27 (0.30–17.31) | 0.43 |
| PEEP, cm H20 | 5.54 (11.30) | 5.55 (11.43) | 5.35 (3.24) | 0.99 (0.95–1.04) | 0.91 |
| Lung Protective PEEP >= 5cm H20) | 82.15 | 82.20 | 80.00 | 0.86 (0.46–1.64) | 0.66 |
| Intraoperative blood products | |||||
| Any blood product | 19.30 | 18.95 | 33.33 | 2.18 (1.26–3.78) | < 0.01 |
| Red blood cells (units) | 0.28 (0.84) | 0.28 (0.84) | 0.46 (0.89) | 1.18 (0.96–1.47) | 0.12 |
| Fresh frozen plasma (units) | 0.07 (0.60) | 0.07 (0.61) | 0.10 (0.40) | 1.06 (0.79–1.42) | 0.69 |
| Platelets (units) | 0.12 (0.55) | 0.12(0.55) | 0.25(0.63) | 1.25 (0.97–1.61) | 0.08 |
| Cryoprecipitate | 0.02 (0.35) | 0.02( 0.35) | 0.06 (0.36) | 1.18 (0.82–1.68) | 0.37 |
| Postoperative ventilation | |||||
| Highest Tidal Volume, mL | 573.38 (162.91) | 572.63 (163.39) | 602.86 (140.76) | 1.00 (0.99–1.00) | 0.20 |
| Lung Protective Tidal Volume (< 8 mL/Kg) | 3.72 | 3.68 | 5.08 | 1.40 (0.43–4.56) | 0.57 |
| PIP, cm H20 | 21.05 (7.54) | 20.95 (7.30) | 25.21 (13.61) | 1.06 (1.03–1.09) | <0.001 |
| Lung Protective PIP <= 30 cm H20) | 87.95 | 88.27 | 75.00 | 0.39 (0.22–0.72) | 0.003 |
| Composite intervention: Appropriate PEEP (> =5 cm) and PIP (<= 30cm) | 71.23 | 71.59 | 56.67 | 0.51 (0.31–0.87) | 0.013 |
| Prolonged ventilation† | |||||
| Postoperative ventilation < 6 hours | 61.20 | 61.85 | 35.00 | 0.33 (0.19–0.57) | <0.001 |
| Daily assessment of oral care with CHG (n = 152) | 76.32 | 74.77 | 80.49 | 0.62 (0.22–1.74) | 0.37 |
| SAT | 48.03 | 47.32 | 50.00 | 0.67 (0.20–2.27) | 0.53 |
| SBT | 57.89 | 57.14 | 60.00 | 0.97 (0.31–3.02) | 0.96 |
| SBT following SAT | 43.71 | 41.07 | 51.28 | 1.30 (0.24–7.02) | 0.76 |
| Subglottic suctioning | 19.94 | 19.65 | 31.67 | 2.21 (1.22–4.01) | 0.009 |
| Use of post-operative bronchodilator | 47.10 | 46.24 | 81.67 | 5.16 (2.67–9.97) | <0.001 |
| Ambulation‡ | |||||
| Ambulation to chair | 95.41 | 95.38 | 96.67 | 0.72 (0.09–5.43) | 0.76 |
| Time to ambulation to chair, (half-days) [median (IQR)] | 1.17 (0.73–1.70) | 1.17 (0.74–1.68) | 1.77 (0.60–6.11) | 1.00 (0.99–1.00) | 0.78 |
| Ambulation | 94.88 | 95.21 | 81.67 | 0.08 (0.04–0.18) | <0.001 |
| Time to ambulation (half-days) [median (IQR)] | 1.08 (0.25–2.61) | 1.01 (0.25–2.56) | 3.33 (0.66–10.14) | 1.00 (0.99–1.00) | 0.63 |
| Ambulation > 150 ft | 75.38 | 76.34 | 36.67 | 0.11 (0.059–0.20) | <0.001 |
| Time to ambulation > 150 ft (half-days) [median (IQR)] | 2.12 (0.54–4.19) | 2.12 (0.51–4.17) | 4.16 (1.42–12.43) | 1.00 (0.99–1.00) | 0.85 |
| Composite intervention: Documentation of progressive postoperative ambulation$ | 74.01 | 74.94 | 36.67 | 0.11 (0.06–0.21) | <0.001 |
Abbreviations: Positive End-Expiratory Pressure (PEEP); Peak Inspiratory Pressure (PIP); Spontaneous awakening trials (SAT); Spontaneous breathing trials (SBT)
Values are percent or mean (SD), unless otherwise noted.
Denominator for “Daily assessment of oral care with CHG”, ”Spontaneous awakening trials”, ”Spontaneous breath trials” was 152 patients. Denominator for “Spontaneous breath trials following Spontaneous awakening trials” was 151 patients.
Ambulation practices were assessed via documentation in the electronic medical record of the following: Ambulation to Chair – Standing, pivoting, and stepping into a bedside chair; Ambulation – Ambulation about the patient’s room, greater than 2 steps; Ambulation > 150ft – Ambulation to a distance greater than 150 feet. Time to ambulation practices were exclusive: i.e. time to ambulation to chair = Date/Time of ambulation to chair – extubation date/time; time to ambulation = Date/time of ambulation – date/time of ambulation to chair; time to ambulation > 150 ft =Date/time of ambulation > 150 ft – date/time of ambulation.
Documentation of Ambulation and ambulation > 150 ft, relative to patients who were documented as having not achieved ambulation or ambulation > 150 ft