Early-Onset Ventilator-Associated Pneumonia in Patients with Severe Traumatic Brain Injury: Incidence, Risk Factors, and Consequences in Cerebral Oxygenation and Outcome

• Published in: Neurocritical care 2017-10, Vol.27 (2), p.187-198
• Main Authors: Esnault, Pierre, Nguyen, Cédric, Bordes, Julien, D’Aranda, Erwan, Montcriol, Ambroise, Contargyris, Claire, Cotte, Jean, Goutorbe, Philippe, Joubert, Christophe, Dagain, Arnaud, Boret, Henry, Meaudre, Eric
• Format: Article
• Language: English
• Subjects: Adult; Antibiotics; Brain Injuries, Traumatic - epidemiology; Brain Injuries, Traumatic - metabolism; Brain Injuries, Traumatic - therapy; Critical Care Medicine; Disease prevention; Female; Follow-Up Studies; France - epidemiology; Humans; Hypothermia, Induced - adverse effects; Hypothermia, Induced - statistics & numerical data; Intensive; Intensive Care Units - statistics & numerical data; Internal Medicine; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neurology; Neurosciences; Original Article; Outcome Assessment (Health Care) - statistics & numerical data; Oxygen Consumption - physiology; Patients; Pneumonia; Pneumonia, Ventilator-Associated - epidemiology; Pneumonia, Ventilator-Associated - etiology; Retrospective Studies; Risk Factors; Suction - adverse effects; Suction - statistics & numerical data; Thoracic Injuries - complications; Thoracic Injuries - epidemiology; Traumatic brain injury; Ventilators; Young Adult
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-017-0397-4

Background Early-onset ventilator-associated pneumonia (EOVAP) occurs frequently in severe traumatic brain-injured patients, but potential consequences on cerebral oxygenation and outcome have been poorly studied. The objective of this study was to describe the incidence, risk factors for, and consequences on cerebral oxygenation and outcome of EOVAP after severe traumatic brain injury (TBI). Methods We conducted a retrospective, observational study including all intubated TBI admitted in the trauma center. An EOVAP was defined as a clinical pulmonary infection score >6, and then confirmed by an invasive method. Patient characteristics, computed tomography (CT) scan results, and outcome were extracted from a prospective register of all intubated TBI admitted in the intensive care unit (ICU). Data concerning the cerebral oxygenation monitoring by PbtO 2 and characteristics of EOVAP were retrieved from patient files. Multivariate logistic regression models were developed to determine the risk factors of EOVAP and to describe the factors independently associated with poor outcome at 1-year follow-up. Results During 7 years, 175 patients with severe TBI were included. The overall incidence of EOVAP was 60.6% (47.4/1000 days of ventilation). Significant risk factors of EOVAP were: therapeutic hypothermia (OR 3.4; 95% CI [1.2–10.0]), thoracic AIS score ≥3 (OR 2.4; 95% CI [1.1–5.7]), and gastric aspiration (OR 5.2, 95% CI [1.7–15.9]). Prophylactic antibiotics administration was a protective factor against EOVAP (OR 0.3, 95% CI [0.1–0.8]). EOVAP had negative consequences on cerebral oxygenation. The PbtO 2 was lower during EOVAP: 23.5 versus 26.4 mmHg ( p