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Minor change in initial PEEP setting decreases rates of ventilator-associated events in mechanically ventilated trauma patients
  1. Ethan Ferrel1,
  2. Kristina M Chapple1,
  3. Liviu Gabriel Calugaru2,
  4. Jennifer Maxwell2,
  5. Jessica A Johnson2,
  6. Andrew W Mezher1,
  7. James N Bogert1,
  8. Hahn Soe-Lin1,
  9. Jordan A Weinberg2
  1. 1Creighton University School of Medicine Phoenix Regional Campus, Phoenix, Arizona, USA
  2. 2Department of Surgery, Dignity Health/St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
  1. Correspondence to Dr Jordan A Weinberg; Jordan.Weinberg{at}


Background Surveillance of ventilator-associated events (VAEs) as defined by the National Healthcare Safety Network (NHSN) is performed at many US trauma centers and considered a measure of healthcare quality. The surveillance algorithm relies in part on increases in positive end-expiratory pressure (PEEP) to identify VAEs. The purpose of this cohort study was to evaluate the effect of initiating mechanically ventilated trauma patients at marginally higher PEEP on incidence of VAEs.

Methods Analysis of level-1 trauma center patients mechanically ventilated 2+ days from 2017 to 2018 was performed after an institutional ventilation protocol increased initial PEEP setting from 5 (2017) to 6 (2018)cm H2O. Incidence of VAEs per 1000 vent days was compared between PEEP groups. Logistic regression modelling was performed to evaluate the impact of the PEEP setting change adjusted to account for age, ventilator days, injury mechanism and injury severity.

Results 519 patients met study criteria (274 PEEP 5 and 245 PEEP 6). Rates of VAEs were significantly reduced among patients with initial PEEP 5 versus 6 (14.61 per 1000 vent days vs. 7.13 per 1000 vent days; p=0.039). Logistic regression demonstrated that initial PEEP 6 was associated with 62% reduction in VAEs.

Conclusions Our data suggest that an incrementally increased baseline PEEP setting was associated with a significantly decreased incidence of VAEs among trauma patients. This minor change in practice may have a major impact on a trauma center’s quality metrics.

Level of evidence IV.

  • critical care
  • intubation
  • respiration, artificial
  • guideline

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  • Presented at Presented at the 78th Annual Meeting of the American Association for the Surgery of Trauma, September 18-21, 2019 in Dallas, Texas.

  • Contributors EF participated in the study design and interpretation. KMC participated in the data collection, analysis, and manuscript preparation, LGC participated in the study design and interpretation. JM participated in the data collection and interpretation. JAJ participated in the data collection and interpretation. AWM participated in the data collection and interpretation. JNB participated in the study design,interpretation, and critical review, HS-L participated in the study design,interpretation, and critical review. JAW participated in the study design,interpretation, and critical review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study obtained approval from the St. Joseph’s Hospital and Medical Center’s internal Institutional Review Board. Approval number: PHXA-18-500-235-73-21.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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