Background: No large prospective data 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 patients' outcome. Study design: and Methods: Analysis of the CENTER-TBI dataset, a large, multicenter, prospective, observational study including TBI patients admitted to European intensive care units (ICU), mechanically ventilated for ≥48 hours, and with an ICU length of stay (LOS) ≥72 hours. Characteristics of VAP vs non VAP patients were compared, and outcome was assessed at 6 months after injury using the extended Glasgow Outcome Scale. Results: 962 patients were included. 196 (20.4%) developed a VAP at a median interval of 5 days (interquartile range (IQR): 3-7 days) from intubation. Patients who developed VAP were younger (median age 39.5 yrs. IQR: 30-66 vs. 51 IQR: 25-55, p<0.001), with a higher incidence of alcohol (36.6% vs. 27.6%, p=0.026) and drug abuse (10.1% vs. 4.3%, p=0.009), more frequent thoracic trauma (53% vs. 43%, p=0.014), and experienced more episodes of respiratory failure during ICU stay (69.9% vs. 28.1%, p<0.001). Age (HR=0.99, 95%Confidence Interval, CI=0.98-0.99,p=0.001), chest trauma (HR=1.4,95%CI 1.03-1.90, p=0.033), H2-receptor antagonist intake (HR=2.16, 1.37-3.39,p=0.001) and antibiotic prophylaxis (HR= 0.69, 95% CI 0.50- 0.96,p=0.026) 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 days, IQR: 5-14, p<0.001) and ICU LOS (median 20 days IQR: 14-29 days vs. 13 days IQR: 8-21 days, p<0.001). 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.

Robba, C., Rebora, P., Banzato, E., Wiegers, E., Stocchetti, N., Menon, D., et al. (2020). 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. CHEST, 158(Issue 6, December 2020), 2292-2303 [10.1016/j.chest.2020.06.064].

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

Rebora, Paola;Banzato, Erika;Citerio, Giuseppe
2020

Abstract

Background: No large prospective data 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 patients' outcome. Study design: and Methods: Analysis of the CENTER-TBI dataset, a large, multicenter, prospective, observational study including TBI patients admitted to European intensive care units (ICU), mechanically ventilated for ≥48 hours, and with an ICU length of stay (LOS) ≥72 hours. Characteristics of VAP vs non VAP patients were compared, and outcome was assessed at 6 months after injury using the extended Glasgow Outcome Scale. Results: 962 patients were included. 196 (20.4%) developed a VAP at a median interval of 5 days (interquartile range (IQR): 3-7 days) from intubation. Patients who developed VAP were younger (median age 39.5 yrs. IQR: 30-66 vs. 51 IQR: 25-55, p<0.001), with a higher incidence of alcohol (36.6% vs. 27.6%, p=0.026) and drug abuse (10.1% vs. 4.3%, p=0.009), more frequent thoracic trauma (53% vs. 43%, p=0.014), and experienced more episodes of respiratory failure during ICU stay (69.9% vs. 28.1%, p<0.001). Age (HR=0.99, 95%Confidence Interval, CI=0.98-0.99,p=0.001), chest trauma (HR=1.4,95%CI 1.03-1.90, p=0.033), H2-receptor antagonist intake (HR=2.16, 1.37-3.39,p=0.001) and antibiotic prophylaxis (HR= 0.69, 95% CI 0.50- 0.96,p=0.026) 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 days, IQR: 5-14, p<0.001) and ICU LOS (median 20 days IQR: 14-29 days vs. 13 days IQR: 8-21 days, p<0.001). 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.
Articolo in rivista - Articolo scientifico
outcome; oxygenation; traumatic brain injury; ventilator associated pneumonia; mechanical ventilation; TBI; VAP;
English
4-lug-2020
2020
158
Issue 6, December 2020
2292
2303
reserved
Robba, C., Rebora, P., Banzato, E., Wiegers, E., Stocchetti, N., Menon, D., et al. (2020). 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. CHEST, 158(Issue 6, December 2020), 2292-2303 [10.1016/j.chest.2020.06.064].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/278934
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