Incidence, Risk Factors, and Effects on Outcome of Ventilator-Associated Pneumonia in Patients With Traumatic Brain Injury

Abstract

Background:No large prospective data, to our knowledge, are available on ventilator-associated pneumonia (VAP) in patients with traumatic brain injury (TBI). Research question:To evaluate the incidence, timing, and risk factors of VAP after TBI and its effect on patient outcome. Study design and methods: This analysis is of the Collaborative European NeuroTraumaEffectiveness Research in Traumatic Brain Injury data set, from a large, multicenter, prospective, observational study including patients with TBI admitted to European ICUs, receiving mechanical ventilation for ≥ 48 hours and with an ICU length of stay (LOS) ≥ 72 hours. Characteristics of patients with VAP vs characteristics of patients without VAP were compared, and outcome was assessed at 6 months after injury by using the Glasgow Outcome Scale Extended. Results:The study included 962 patients: 196 (20.4%) developed a VAP at a median interval of 5 days (interquartile range [IQR], 3-7 days) after intubation. Patients who developed VAP were younger

Post‐craniotomy fever and its associated factors in patients with traumatic brain injury

“…About 36.6% of these patients developed early‐onset VAP. This incidence rate is similar to a 36% (95% confidence interval [CI] [31, 41]), reported in a meta‐analysis 23 ; but higher than a 20.4% reported in Robba et al 24 study (n = 962) and a 24.3% reported in Jovanovic et al 25 study (n = 144). The discrepancy may be partially explained by a VAP bundle that had not yet been implemented during our study's retrospective data collection period.…”

Brain-lung interaction: a vicious cycle in traumatic brain injury

“…The clinical case of a patient with thoracic and brain trauma who subsequently developed ARDS showed an improvement in lung function indices with moderate and very transient effects of ICP that resolved shortly after the change in position (supine position) [ 61 ]. Nevertheless, this maneuver has been poorly studied in patients with brain injuries, so prone positioning may be considered in patients with concurrent severe ARDS (PaO 2 /FiO 2 ratio <150) and TBI but do not have significant ICP elevation [ 62 ].…”

Electrical Impedance Tomography Predicts Weaning Success in Adult Patients With Delayed Upper Abdominal Surgery: A Single-Center Retrospective Study

“…In addition, due to the effects of anesthesia, mechanical ventilation, and changes in intrathoracic and abdominal pressure, the occurrence of early postoperative atelectasis is almost inevitable. Notably, early ventilator withdrawal can effectively prevent the occurrence of ventilator-associated pneumonia ( 17 ). Accordingly, for patients with mechanical ventilation after upper abdominal surgery, clinicians need to actively find an appropriate time to speed up the process of ventilator withdrawal to reduce the delayed extubation.…”