A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
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
Tekijät: Robba C, Rebora P, Banzato E, Wiegers EJA, Stocchetti N, Menon DK, Citerio G; on behalf of the
Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Participants and Investigators
Kustantaja: ELSEVIER
Julkaisuvuosi: 2020
Journal: Chest
Tietokannassa oleva lehden nimi: CHEST
Lehden akronyymi: CHEST
Vuosikerta: 158
Numero: 6
Aloitussivu: 2292
Lopetussivu: 2303
Sivujen määrä: 12
ISSN: 0012-3692
eISSN: 0012-3692
DOI: https://doi.org/10.1016/j.chest.2020.06.064
Rinnakkaistallenteen osoite: https://air.unimi.it/handle/2434/772526
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.
