Table 3: Hazard ratios of patient and ventilation characteristics – results of multivariate analysis. Hazard ratio (95% CI) p‐value Age 16 – 40 2.42 (1.07, 5.50) 0.036 40 – 60 Ref 60 – 80 1.21 (0.62, 2.34) 0.567 > 80 1.58 (0.66, 3.75) 0.305 COPD 0.19 (0.04, 0.78) 0.003 Sedation score, per day (current) 1 0.08 (0.01, 0.58) < 0.001 2 0.67 (0.30, 1.54) 0.335 3 0.46 (0.20, 1.03) 0.048 4 0.43 (0.21, 0.90) 0.062 5 0.77 (0.43, 1.39) 0.388 6 Ref Oropharyngeal prophylaxis (current) 0.19 (0.04, 0.91) 0.017 Intravenous antibiotics for SDD (ivSDD) ‐ (WCE) See Fig 4A 0.062 Other systemic AB (not for ivSDD) ‐ (WCE) See Fig 4B < 0.001 Inhalation therapy ‐ (WCE) See Fig 4C 0.009 Jet nebulizer (compared to no inhalation therapy) Metered dose inhaler (MDI) (compared to no inhalation therapy) The model suggests that, compared to patients between 40 and 60 years of age, patients ≤ 40 had an over two‐fold higher risk of developing VAP. Patients were also at an increased risk when their sedation scores were high. Patients who were on SOD, ivSDD or ivAB and patients with COPD had a lower VAP risk. The model further demonstrates a delayed protective effect of ivSDD by three days. This protective effect is afforded for 24 days (up to 27 days back) (Fig 4A). IvAB was protective for two days, with the protection being afforded after a delay of one day. The effect from inhalation therapy was minimal, with jet nebulizers showing a delayed protective effect for days 6 to 8 back. Our results were not sensitive to using the last observation carry forward approach for completing missing data. Similar results were obtained when we removed admissions with missing time‐varying data from the dataset and reran the multivariate model. 4 75 Risk factors for VAP using flexible methods
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