Traumatic Brain Injury as an Independent Predictor of Lobar Collapse

Akella, Krishna; Akella, S.; Aleti, Sireesha; Chendrasekhar, Akella

doi:10.1016/j.chest.2017.08.397

Cited by 2 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Severe TBI increases the risk of infection during hospitalization, including pneumonia [1][2][3]. Although the increased infection risk and pneumonia rates are well known [7,9], we found that in addition to the risk above factors, patients with severe TBI developed radiographic lobar collapse at a higher frequency than patients without TBI [10]. The etiology of this increased rate of lobar collapse is unclear but does not seem to be attributable to osmolar therapy use among severe TBI patients [10].…”

Section: Discussionmentioning

confidence: 64%

“…In a previous study conducted at our institution, we compared patients who were intubated for more than 24 hours with similar ISS and either severe TBI or no TBI and found that the incidence of pneumonia was significantly higher in patients with severe TBI (39.6% versus 26.9%, p=0.05). We also found that patients with severe TBI who were intubated more than 24 hours were more prone to develop lobar collapse as detected by chest radiography and which necessitated advanced directional suctioning and/or bronchoscopy (27.7 % versus 11.5 %, p=0.003) [10].…”

Section: Introductionmentioning

confidence: 62%

“…Having noted the frequency of lobar collapse, we implemented a pulmonary hygiene protocol and in the present retrospective analysis, demonstrated decreased incidence of radiographic lobar collapse but no change in the incidence of pneumonia. Other studies also note that the incidence of pneumonia is not reduced by similar pulmonary hygiene protocols [10,12]; however, the increased lobar collapse rate seen in severe TBI patients approximated ISS-matched non-TBI patients after implementation of the pulmonary hygiene protocol. This suggests that a pulmonary hygiene protocol may counteract TBI-related pathophysiologic processes associated with increased rates of lobar collapse even if rates of pneumonia and other outcomes remain unchanged.…”

Section: Discussionmentioning

confidence: 98%

See 2 more Smart Citations

1789: Pulmonary Hygiene Protocol Reduces Incidence of Lobar Collapse in Severe Traumatic Brain Injury

Chow

Akella

Chendrasekhar

2019

Critical Care Medicine

View full text Add to dashboard Cite

BackgroundTraumatic brain injury (TBI) is a common cause of death among injured patients. In addition to neurologic sequelae which may increase mortality risk, trauma patients suffering severe TBI (Glasgow Coma Score≤8) have a predilection for pulmonary complications. We have previously demonstrated that patients with severe TBI who were intubated and mechanically ventilated are at greater risk of radiographic pulmonary lobar collapse that necessitates advanced directional suctioning and/or bronchoscopy. We sought to minimize the potentially deleterious effects of such lobar collapse by using a standardized pulmonary hygiene protocol. MethodsWe performed a retrospective comparison of lobar collapse incidence among three groups over 21 months: patients without severe TBI who were intubated and mechanically ventilated for greater than 24 hours (i.e. "NO TBI"); patients with severe TBI who were intubated and mechanically ventilated for greater than 24 hours who were not treated with a standardized pulmonary hygiene protocol (i.e. historical "CONTROL"); and patients with severe TBI who were intubated and mechanically ventilated for greater than 24 hours and who were treated with a standardized pulmonary hygiene protocol (i.e. "HYGIENE"). Our analysis excluded patients who had any significant neck injury as we had previously found that pulmonary complications are increased in this subpopulation. ResultsWe reviewed the charts of 310 trauma patients (NO TBI = 104, CONTROL = 101, HYGIENE = 105) and analyzed demographics, injury severity and outcomes, including the incidence of pulmonary lobar collapse. Pulmonary hygiene protocol demonstrated a significant reduction in the incidence of lobar collapse among the HYGIENE group compared to CONTROL, approximating the incidence among patients with no TBI (11% vs 27% vs 10%, respectively, p = 0.0009). No significant difference was noted in ventilator days, intensive care unit length of stay, hospital length of stay, mortality, nor incidence of pneumonia. ConclusionHigh-risk TBI patients have a predilection towards the development of pulmonary lobar collapse, which can be significantly reduced by the use of a standardized pulmonary hygiene protocol.

show abstract

Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

1789: Pulmonary Hygiene Protocol Reduces Incidence of Lobar Collapse in Severe Traumatic Brain Injury

Chow

Akella

Chendrasekhar

2019

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Severe TBI increases the risk of infection during hospitalization, including pneumonia [ 1 - 3 ]. Although the increased infection risk and pneumonia rates are well known [ 7 , 9 ], we found that in addition to the risk above factors, patients with severe TBI developed radiographic lobar collapse at a higher frequency than patients without TBI [ 10 ]. The etiology of this increased rate of lobar collapse is unclear but does not seem to be attributable to osmolar therapy use among severe TBI patients [ 10 ].…”

Section: Discussionmentioning

confidence: 99%