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
Chiara Robba, Paola Rebora, Erika Banzato, Eveline J A Wiegers, Nino Stocchetti, David K Menon, Giuseppe Citerio, Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Participants and Investigators, Cecilia Åkerlund, David Nelson, Krisztina Amrein, József Nyirádi, Nada Andelic, Lasse Andreassen, Audny Anke, Gérard Audibert, Philippe Azouvi, Maria Luisa Azzolini, Luigi Beretta, Maria Rosa Calvi, Ronald Bartels, Hugo den Boogert, Ronny Beer, Raimund Helbok, Bo-Michael Bellander, Habib Benali, Vincent Degos, Damien Galanaud, Vincent Perlbarg, Audrey Vanhaudenhuyse, Maurizio Berardino, Morten Blaabjerg, Stine Borgen Lund, Camilla Brorsson, Andras Buki, Endre Czeiter, Manuel Cabeleira, Marek Czosnyka, Peter Smielewski, Alessio Caccioppola, Emiliana Calappi, Marco Carbonara, Davide Mulazzi, Fabrizio Ortolano, Tommaso Zoerle, Peter Cameron, Dashiell Gantner, Lynnette Murray, Tony Trapani, Shirley Vallance, Guillermo Carbayo Lozano, Inigo Pomposo, Ana M Castaño-León, Pedro A Gomez, Alfonso Lagares, Giorgio Chevallard, Arturo Chieregato, Giuseppe Citerio, Mark Coburn, Ana Kowark, Rolf Rossaint, Jonathan Coles, Jamie D Cooper, Marta Correia, Claire Dahyot-Fizelier, Véronique De Keyser, Andrew I R Maas, Tomas Menovsky, Nandesh Nair, Gregory Van der Steen, Francesco Della Corte, Francesca Grossi, Bart Depreitere, Dula Dilvesi, Jagos Golubovic, Mladen Karan, Petar Vulekovic, Abhishek Dixit, Ari Ercole, Evgenios Koraropoulos, David Menon, Virginia Newcombe, Sophie Richter, Emmanuel Stamatakis, Guy Williams, Stefan Winzeck, Frederik A Zeiler, Jens Dreier, Guy-Loup Dulière, Hugues Maréchal, Erzsébet Ezer, Zoltán Vámos, Martin Fabricius, Daniel Kondziella, Kelly Foks, Shirin Frisvold, Alex Furmanov, Guy Rosenthal, Alexandre Ghuysen, Lelde Giga, Egils Valeinis, Agate Ziverte, Deepak Gupta, Iain Haitsma, Victor Volovici, Eirik Helseth, Peter J Hutchinson, Angelos G Kolias, Stefan Jankowski, Lars-Owe Koskinen, Noémi Kovács, Steven Laureys, Quentin Noirhomme, Audrey Vanhaudenhuyse, Aurelie Lejeune, Emmanuel Vega, Roger Lightfoot, Ewout W Steyerberg, Hester Lingsma, Daphne Voormolen, Alex Manara, Matt Thomas, Costanza Martino, Julia Mattern, Oliver Sakowitz, Alexander Younsi, Catherine McMahon, Visakh Muraleedharan, Ancuta Negru, Horia Ples, Cristina Maria Tudora, Jean-François Payen, Paolo Persona, Sandra Rossi, Wilco Peul, Jeroen T J M van Dijck, Thomas A van Essen, Roel P J van Wijk, Anna Piippo-Karjalainen, Rahul Raj, Jussi P Posti, Olli Tenovuo, Louis Puybasset, Andreea Radoi, Juan Sahuquillo, Arminas Ragauskas, Saulius Rocka, Jonathan Rhodes, Cecilie Roe, Olav Roise, Jeffrey V Rosenfeld, Christina Rosenlund, Oddrun Sandro, Kari Schirmer-Mikalsen, Oliver Sakowitz, Renan Sanchez-Porras, Kari Schirmer-Mikalsen, Anne Vik, Rico Frederik Schou, Abayomi Sorinola, Viktória Tamás, Ewout W Steyerberg, Nino Stocchetti, Nina Sundström, Riikka Takala, Tomas Tamosuitis, Dick Tibboel, Christos Tolias, Peter Vajkoczy, Alessia Vargiolu, Anne Vik, Rimantas Vilcinis, Stefan Wolf, Frederik A Zeiler, Chiara Robba, Paola Rebora, Erika Banzato, Eveline J A Wiegers, Nino Stocchetti, David K Menon, Giuseppe Citerio, Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Participants and Investigators, Cecilia Åkerlund, David Nelson, Krisztina Amrein, József Nyirádi, Nada Andelic, Lasse Andreassen, Audny Anke, Gérard Audibert, Philippe Azouvi, Maria Luisa Azzolini, Luigi Beretta, Maria Rosa Calvi, Ronald Bartels, Hugo den Boogert, Ronny Beer, Raimund Helbok, Bo-Michael Bellander, Habib Benali, Vincent Degos, Damien Galanaud, Vincent Perlbarg, Audrey Vanhaudenhuyse, Maurizio Berardino, Morten Blaabjerg, Stine Borgen Lund, Camilla Brorsson, Andras Buki, Endre Czeiter, Manuel Cabeleira, Marek Czosnyka, Peter Smielewski, Alessio Caccioppola, Emiliana Calappi, Marco Carbonara, Davide Mulazzi, Fabrizio Ortolano, Tommaso Zoerle, Peter Cameron, Dashiell Gantner, Lynnette Murray, Tony Trapani, Shirley Vallance, Guillermo Carbayo Lozano, Inigo Pomposo, Ana M Castaño-León, Pedro A Gomez, Alfonso Lagares, Giorgio Chevallard, Arturo Chieregato, Giuseppe Citerio, Mark Coburn, Ana Kowark, Rolf Rossaint, Jonathan Coles, Jamie D Cooper, Marta Correia, Claire Dahyot-Fizelier, Véronique De Keyser, Andrew I R Maas, Tomas Menovsky, Nandesh Nair, Gregory Van der Steen, Francesco Della Corte, Francesca Grossi, Bart Depreitere, Dula Dilvesi, Jagos Golubovic, Mladen Karan, Petar Vulekovic, Abhishek Dixit, Ari Ercole, Evgenios Koraropoulos, David Menon, Virginia Newcombe, Sophie Richter, Emmanuel Stamatakis, Guy Williams, Stefan Winzeck, Frederik A Zeiler, Jens Dreier, Guy-Loup Dulière, Hugues Maréchal, Erzsébet Ezer, Zoltán Vámos, Martin Fabricius, Daniel Kondziella, Kelly Foks, Shirin Frisvold, Alex Furmanov, Guy Rosenthal, Alexandre Ghuysen, Lelde Giga, Egils Valeinis, Agate Ziverte, Deepak Gupta, Iain Haitsma, Victor Volovici, Eirik Helseth, Peter J Hutchinson, Angelos G Kolias, Stefan Jankowski, Lars-Owe Koskinen, Noémi Kovács, Steven Laureys, Quentin Noirhomme, Audrey Vanhaudenhuyse, Aurelie Lejeune, Emmanuel Vega, Roger Lightfoot, Ewout W Steyerberg, Hester Lingsma, Daphne Voormolen, Alex Manara, Matt Thomas, Costanza Martino, Julia Mattern, Oliver Sakowitz, Alexander Younsi, Catherine McMahon, Visakh Muraleedharan, Ancuta Negru, Horia Ples, Cristina Maria Tudora, Jean-François Payen, Paolo Persona, Sandra Rossi, Wilco Peul, Jeroen T J M van Dijck, Thomas A van Essen, Roel P J van Wijk, Anna Piippo-Karjalainen, Rahul Raj, Jussi P Posti, Olli Tenovuo, Louis Puybasset, Andreea Radoi, Juan Sahuquillo, Arminas Ragauskas, Saulius Rocka, Jonathan Rhodes, Cecilie Roe, Olav Roise, Jeffrey V Rosenfeld, Christina Rosenlund, Oddrun Sandro, Kari Schirmer-Mikalsen, Oliver Sakowitz, Renan Sanchez-Porras, Kari Schirmer-Mikalsen, Anne Vik, Rico Frederik Schou, Abayomi Sorinola, Viktória Tamás, Ewout W Steyerberg, Nino Stocchetti, Nina Sundström, Riikka Takala, Tomas Tamosuitis, Dick Tibboel, Christos Tolias, Peter Vajkoczy, Alessia Vargiolu, Anne Vik, Rimantas Vilcinis, Stefan Wolf, Frederik A Zeiler
Abstract
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.
Keywords: mechanical ventilation; outcome; oxygenation; traumatic brain injury; ventilator-associated pneumonia.
Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
Source: PubMed