Early pneumonia diagnosis decreases ventilator-associated pneumonia rates in trauma population

Harrell, Kevin N.; Lee, William B.; Rooks, Hunter J.; Briscoe, W. Eric; Capote, Walter; Dart, Benjamin W.; Hunt, Darren J.; Maxwell, Robert A.

doi:10.1097/ta.0000000000003808

Cited by 7 publications

(7 citation statements)

References 24 publications

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“…The reduced consciousness also makes the ABI patients more susceptible for aspiration pneumonia, impaired mucus clearance and VAP than ICU patients without ABI [ 19 , 22 , 23 ]. In a recent large European cohort of about thousand patients with TBI, one out of five developed VAP after a median interval of 5 days (interquartile range 3–7 days, indicating that 75% of episodes occurred in the first week of MV) [ 24 ].…”

Section: Respiratory Challenges In Patients With Abimentioning

confidence: 99%

“…In a recent large European cohort of about thousand patients with TBI, one out of five developed VAP after a median interval of 5 days (interquartile range 3–7 days, indicating that 75% of episodes occurred in the first week of MV) [ 24 ]. Systematic performance of bronchoalveolar lavage within 24 h after intubation of trauma patients showed that 80% of samples grew some microorganisms and 30% are suspect of early pneumonia [ 22 ].…”

Section: Respiratory Challenges In Patients With Abimentioning

confidence: 99%

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Respiratory challenges and ventilatory management in different types of acute brain-injured patients

et al. 2023

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Acute brain injury (ABI) covers various clinical entities that may require invasive mechanical ventilation (MV) in the intensive care unit (ICU). The goal of MV, which is to protect the lung and the brain from further injury, may be difficult to achieve in the most severe forms of lung or brain injury. This narrative review aims to address the respiratory issues and ventilator management, specific to ABI patients in the ICU.

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Section: Respiratory Challenges In Patients With Abimentioning

confidence: 99%

Section: Respiratory Challenges In Patients With Abimentioning

confidence: 99%

Respiratory challenges and ventilatory management in different types of acute brain-injured patients

et al. 2023

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“…Infections related to trauma often affect multiple organs and can manifest early, within the first four days. This holds true in trauma patients with contaminated wounds and fractures (18), early aspiration pneumonia in brain-injured patients (19), or superinfection of lung contusions (20). Some trauma patients may experience systemic inflammatory response syndrome (SIRS), while others may exhibit a compensatory anti-inflammatory response syndrome (CARS) (21), both leading to a modulated inflammatory response.…”

Section: Introductionmentioning

confidence: 99%

Identifying biomarkers deciphering sepsis from trauma-induced sterile inflammation and trauma-induced sepsis

Papareddy,

Selle,

Partouche

et al. 2024

Front. Immunol.

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ObjectiveThe purpose of this study was to identify a panel of biomarkers for distinguishing early stage sepsis patients from non-infected trauma patients.BackgroundAccurate differentiation between trauma-induced sterile inflammation and real infective sepsis poses a complex life-threatening medical challenge because of their common symptoms albeit diverging clinical implications, namely different therapies. The timely and accurate identification of sepsis in trauma patients is therefore vital to ensure prompt and tailored medical interventions (provision of adequate antimicrobial agents and if possible eradication of infective foci) that can ultimately lead to improved therapeutic management and patient outcome. The adequate withholding of antimicrobials in trauma patients without sepsis is also important in aspects of both patient and environmental perspective.MethodsIn this proof-of-concept study, we employed advanced technologies, including Matrix-Assisted Laser Desorption/Ionization (MALDI) and multiplex antibody arrays (MAA) to identify a panel of biomarkers distinguishing actual sepsis from trauma-induced sterile inflammation.ResultsBy comparing patient groups (controls, infected and non-infected trauma and septic shock patients under mechanical ventilation) at different time points, we uncovered distinct protein patterns associated with early trauma-induced sterile inflammation on the one hand and sepsis on the other hand. SYT13 and IL1F10 emerged as potential early sepsis biomarkers, while reduced levels of A2M were indicative of both trauma-induced inflammation and sepsis conditions. Additionally, higher levels of TREM1 were associated at a later stage in trauma patients. Furthermore, enrichment analyses revealed differences in the inflammatory response between trauma-induced inflammation and sepsis, with proteins related to complement and coagulation cascades being elevated whereas proteins relevant to focal adhesion were diminished in sepsis.ConclusionsOur findings, therefore, suggest that a combination of biomarkers is needed for the development of novel diagnostic approaches deciphering trauma-induced sterile inflammation from actual infective sepsis.

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“…Thank you to Drs. Ross, Ness, and Cocanour for their insightful comments regarding our article, “Early Pneumonia Diagnosis Decreases Ventilator-Associated Pneumonia Rates in Trauma Population.” 1 We agree that screening bronchoscopy with bronchoalveolar lavage (BAL), as with any screening test, opens the potential for overtreatment. Our protocol was developed with these concerns in mind, with patients needing to meet several thresholds to receive antibiotic treatment for their early pneumonia.…”

mentioning

confidence: 99%

Author response to letter to the editor: “Routine screening bronchoscopy in intubated trauma patients risks unnecessary antibiotic use without clear benefit”

Harrell

Lee

Rooks

et al. 2023

J Trauma Acute Care Surg

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Early pneumonia diagnosis decreases ventilator-associated pneumonia rates in trauma population

Abstract: An early BAL protocol identified trauma patients with early pneumonia, a separate entity from ventilator-associated pneumonia. Patients were treated based on clinical signs. There was no difference in clinical outcomes but reported VAP rate decreased by 28%.

Cited by 7 publications

References 24 publications

Respiratory challenges and ventilatory management in different types of acute brain-injured patients

Respiratory challenges and ventilatory management in different types of acute brain-injured patients

Identifying biomarkers deciphering sepsis from trauma-induced sterile inflammation and trauma-induced sepsis

Author response to letter to the editor: “Routine screening bronchoscopy in intubated trauma patients risks unnecessary antibiotic use without clear benefit”

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