Ventilator-associated pneumonia in neurocritically ill patients: insights from the ENIO international prospective observational study

• Published in: Respiratory research 2023-05, Vol.24 (1), p.146-10, Article 146
• Main Authors: Battaglini, Denise, Parodi, Luca, Cinotti, Raphael, Asehnoune, Karim, Taccone, Fabio Silvio, Orengo, Giovanni, Zona, Gianluigi, Uccelli, Antonio, Ferro, Giulio, Robba, Michela, Pelosi, Paolo, Robba, Chiara
• Format: Article
• Language: English
• Subjects: Body mass index; Brain; Brain cancer; Brain injury; Bronchitis; Care and treatment; Chronic obstructive pulmonary disease; Clinical outcomes; Coma; Comorbidity; Critical care; Critically ill; Diagnosis; Extubation; Female; Gender; Guillain-Barre syndrome; Head injuries; Heterogeneity; Humans; Hypothermia; Hypothermia - complications; Injuries; Intensive care; Male; Males; Mechanical ventilation; Mortality; Neurocritical care; Nosocomial infections; Observational studies; Ostomy; Outcome; Patients; Pneumonia; Pneumonia, Ventilator-Associated - diagnosis; Pneumonia, Ventilator-Associated - epidemiology; Population; Prospective Studies; Regression analysis; Respiration, Artificial - adverse effects; Risk factors; Statistical analysis; Tracheobronchitis; Tracheotomy; Traumatic brain injury; Ventilator-associated pneumonia; Ventilators; Ventilators, Mechanical - adverse effects; Ventricle
• ISSN: 1465-993X; 1465-9921; 1465-993X; 1465-9921
• DOI: 10.1186/s12931-023-02456-9

Acute brain injured (ABI) patients are at high risk of developing ventilator-associated pneumonia (VAP). However, incidence, risk factors and effects on outcome of VAP are not completely elucidated in this population. The primary aim of this study was to determine the incidence of VAP in a cohort of ABI patients. The secondary objectives included the identification of risk factors for development of VAP, and the impact of VAP on clinical outcomes. Clinical outcomes were defined as intensive care unit length of stay (ICU-LOS), duration of invasive mechanical ventilation (IMV), and ICU mortality. Pre-planned sub-analysis of the Extubation strategies in Neuro-Intensive care unit (ICU) patients and associations with Outcomes (ENIO) international multi-center prospective observational study. Patients with available data on VAP, who received at least 48 h of IMV and ICU-LOS ≥ 72 h were included. Out of 1512 patients included in the ENIO study, 1285 were eligible for this analysis. The prevalence of VAP was 39.5% (33.7 cases /1000 ventilator-days), with a high heterogeneity across countries and according to the type of brain injury. VAP was significantly more frequent in male patients, in those with smoke habits and when intraparenchymal probe (IP), external ventricular drain (EVD) or hypothermia (p