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Incidence, Risk Fac...
Incidence, Risk Factors, and Effects on Outcome of Ventilator-Associated Pneumonia in Patients With Traumatic Brain Injury : Analysis of a Large, Multicenter, Prospective, Observational Longitudinal Study
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Robba, Chiara (författare)
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Rebora, Paola (författare)
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Banzato, Erika (författare)
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Wiegers, Eveline J. A. (författare)
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Stocchetti, Nino (författare)
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Menon, David K. (författare)
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Citerio, Giuseppe (författare)
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- Brorsson, Camilla (bidragsgivare)
- Umeå universitet,Institutionen för kirurgisk och perioperativ vetenskap
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- Koskinen, Lars-Owe D., Professor, 1955- (bidragsgivare)
- Umeå universitet,Neurovetenskaper
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- Sundström, Nina (bidragsgivare)
- Umeå universitet,Institutionen för strålningsvetenskaper
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(creator_code:org_t)
- Elsevier, 2020
- 2020
- Engelska.
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Ingår i: Chest. - : Elsevier. - 0012-3692 .- 1931-3543. ; 158:6, s. 2292-2303
- Relaterad länk:
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https://air.unimi.it...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Ämnesord
Stäng
- 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 NeuroTrauma Effectiveness 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 (median age, 39.5 [IQR, 25-55] years vs 51 [IQR, 30-66] years; P < .001), with a higher incidence of alcohol abuse (36.6% vs 27.6%; P = .026) and drug abuse (10.1% vs 4.2%; P = .009), more frequent thoracic trauma (53% vs 43%; P = .014), and more episodes of respiratory failure during ICU stay (69.9% vs 28.1%; P < .001). Age (hazard ratio [HR], 0.99; 95% CI, 0.98-0.99; P = .001), chest trauma (HR, 1.4; 95% CI, 1.03-1.90; P = .033), histamine-receptor antagonist intake (HR, 2.16; 95% CI, 1.37-3.39; P = .001), and antibiotic prophylaxis (HR, 0.69; 95% CI, 0.50-0.96; P = .026) were associated with the risk of VAP. Patients with VAP had a longer duration of mechanical ventilation (median, 15 [IQR, 10-22] days vs 8 [IQR, 5-14] days; P < .001) and ICU LOS (median, 20 [IQR, 14-29] days vs 13 [IQR, 8-21] days; P < .001). However, VAP was not associated with increased mortality or worse neurological outcome. Overall mortality at 6 months was 22%.Interpretation: VAP occurs less often than previously described in patients after TBI and has a detrimental effect on ICU LOS but not on mortality and neurological outcome.Clinical Trial Registration: ClinicalTrials.gov; No.: NCT02210221; URL: www.clinicaltrials.gov
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Lungmedicin och allergi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Respiratory Medicine and Allergy (hsv//eng)
Nyckelord
- mechanical ventilation
- outcome
- oxygenation
- traumatic brain injury
- ventilator-associated pneumonia
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Robba, Chiara
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Rebora, Paola
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Banzato, Erika
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Wiegers, Eveline ...
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Stocchetti, Nino
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Menon, David K.
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Citerio, Giusepp ...
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Brorsson, Camill ...
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Koskinen, Lars-O ...
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Sundström, Nina
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