Antibiotic prophylaxis of early onset pneumonia in critically ill comatose patients. A randomized study

Acquarolo, Annamaria; Urli, T.; Perone, Giovanna; Giannotti, Claudia; Candiani, A; Latronico, Nicola

doi:10.1007/s00134-005-2585-5

Cited by 90 publications

(43 citation statements)

References 27 publications

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“…This incidence was greater than typically observed in the medical literature. Indeed, others series showed an EOVAP incidence of 20-45% in patients with TBIs admitted to the ICU [5,6,8,28,29]. One potential explanation for this discrepancy might be related to the patients included in our study: we analyzed only patients with severe TBIs.…”

Section: Discussioncontrasting

confidence: 46%

“…The median ISS scores were 25 (IQR: [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] for those with EOVAP, and 18 (IQR: 14-32) for those without EOVAP (p = 0.009). The gravity of brain injuries was comparable between the groups, in terms of the median head AIS (5, IQR: 4-5 vs. 5, IQR: 4-5; p = 0.09), the median Marshall score (2.5, IQR: 2-5 vs. 2, IQR: 2-5; p = 0.10), and the median minimal GCS score before sedation (6, IQR: 4-7 vs. 6, IQR: 4-8; p = 0.46).…”

Section: Study Populationmentioning

confidence: 99%

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Early-Onset Ventilator-Associated Pneumonia in Patients with Severe Traumatic Brain Injury: Incidence, Risk Factors, and Consequences in Cerebral Oxygenation and Outcome

et al. 2017

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EOVAP is frequent after a severe TBI (overall rate: 61%), with therapeutic hypothermia, severe thoracic lesion, and gastric aspiration as main risk factors. EOVAP had a negative impact on cerebral oxygenation measured by PbtO and was independently associated with unfavorable outcome at 1-year follow-up. This suggests that all precautions available should be taken to prevent EOVAP in this population.

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Section: Discussioncontrasting

confidence: 46%

Section: Study Populationmentioning

confidence: 99%

Early-Onset Ventilator-Associated Pneumonia in Patients with Severe Traumatic Brain Injury: Incidence, Risk Factors, and Consequences in Cerebral Oxygenation and Outcome

et al. 2017

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“…These conflicting results could be explained by the high rate of late-onset VAP in the current study. Two randomised open studies [36,37] compared a short course of antibiotics to standard treatment in comatose mechanically ventilated patients. Although no difference was found in mortality rates, a significant reduction in early-onset VAP incidence was found in patients who received intravenous antibiotics as compared with those who received standard treatment.…”

Section: S Aureusmentioning

confidence: 99%

Relationship between tracheotomy and ventilator-associated pneumonia: a case–control study

Nseir

Pompéo²,

Jozefowicz³

et al. 2006

Eur Respir J

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The aim of the present study was to determine the relationship between tracheotomy and ventilator-associated pneumonia (VAP).The study used a retrospective case-control study design based on prospective data. All nontrauma immunocompetent patients, intubated and ventilated for .7 days, were eligible for inclusion in the study. A diagnosis of VAP was based on clinical, radiographical and microbiological criteria. Four matching criteria were used, including duration of mechanical ventilation (MV). The indication and timing of tracheotomy were at the discretion of attending physicians. Univariate and multivariate analyses were performed to determine risk factors for VAP in cases (patients with tracheotomy) and controls (patients without tracheotomy).In total, 1,402 patients were eligible for inclusion. Surgical tracheotomy was performed in 226 (16%) patients and matching was successful for 177 (78%). The rate of VAP (22 versus 14 VAP episodes?1,000 MV-days -1 ) was significantly higher in controls than in cases. The rate of VAP after tracheotomy in cases, or after the corresponding day of MV in controls, was also significantly higher in control than in case patients (9.2 versus 4.8 VAP episodes?1,000 MV-days -1). In multivariate analysis, neurological failure (odds ratio (95% confidence interval) 2.7 (1.3-5)), antibiotic treatment (2.1 (1.1-3.2)) and tracheotomy (0.18 (0.1-0.3)) were associated with VAP.In summary, the present study demonstrates that tracheotomy is independently associated with decreased risk for ventilator-associated pneumonia.KEYWORDS: Intensive care, nosocomial pneumonia, risk factors, tracheostomy, tracheotomy, ventilator-associated pneumonia V entilator-associated pneumonia (VAP) occurs in a considerable proportion of patients undergoing mechanical ventilation and is associated with substantial morbidity, two-fold mortality rate and excess cost [1]. Strategies that effectively prevent VAP are needed. Identifying modifiable risk factors for VAP could be helpful for future controlled interventional studies aiming at improving prevention of VAP [2].Short-term tracheotomy is frequently performed in intensive care unit (ICU) patients with weaning difficulties or predicted long periods of mechanical ventilation (MV). According to the results of two recent studies performed on .40,000 patients, 7.7-10.7% of ICU patients receive invasive MV through a tracheotomy cannula during their ICU stay [3,4].Recent studies reported high VAP rates after surgical and percutaneous tracheotomy (25 and 18%, respectively) [5,6]. In these studies, most VAP episodes occurred in the week following the procedure. Unfortunately, the incidence of VAP after tracheotomy was not compared with VAP incidence before tracheotomy, or with VAP incidence in patients without tracheotomy. Several recent studies identified tracheotomy as an independent risk factor for VAP [7][8][9][10]. However, only one study excluded tracheotomy from risk factor analysis when it was performed after VAP occurrence [8]. In addition, none of th...

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“…During rewarming and normothermia maintenance, shivering and heat production were treated with focal counterwarming [21], meperidine, buspirone, dexmedetomidine, propofol, and acetaminophen [18,19]. Patients with pulmonary infiltrates or suspected aspiration routinely received prophylactic antibiotics at the time of admission [22,23]. Mean arterial pressure was maintained >65 mmHg, and glucose between 100 and 139 mg/dl using the Yale Insulin Protocol.…”

Section: Cooling Protocolmentioning

confidence: 99%

Surface Cooling after Cardiac Arrest: Effectiveness, Skin Safety, and Adverse Events in Routine Clinical Practice

et al. 2011

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Antibiotic prophylaxis of early onset pneumonia in critically ill comatose patients. A randomized study

Cited by 90 publications

References 27 publications

Early-Onset Ventilator-Associated Pneumonia in Patients with Severe Traumatic Brain Injury: Incidence, Risk Factors, and Consequences in Cerebral Oxygenation and Outcome

Early-Onset Ventilator-Associated Pneumonia in Patients with Severe Traumatic Brain Injury: Incidence, Risk Factors, and Consequences in Cerebral Oxygenation and Outcome

Relationship between tracheotomy and ventilator-associated pneumonia: a case–control study

Surface Cooling after Cardiac Arrest: Effectiveness, Skin Safety, and Adverse Events in Routine Clinical Practice

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