Risk factors associated with the presence of pneumonia in patients with brain injury
Keywords:
Pneumonia, respiration, artificial, craniocerebral trauma, cross infection, intensive care
Abstract
Introduction. Pneumonia in patients with head trauma occurs commonly; however, few data are available to evaluate the effects of the infection on the prognosis.Objective. The incidence and microbiological findings were described, and the associated risk factors were established with the appearance of pneumonia in patients with severe brain trauma.
Materials and methods. A prospective cohort study was conducted that included 39 patients with severe brain trauma and who required mechanical ventilation; initially, none had pneumonia. These patients were observed during a 24-month period in an attempt to discern the principal risk factors associated with the onset of pneumonia.
Results. Pneumonia occurred in 31 (80%) of the 39 patients, and 28 of these presented early pneumonia. The most frequent germ in patients with pneumonia was Staphylococcus aureus with a percentage of the 42.4%. In the multivariate analysis, the single statistically significant risk factor was the presence of hypotension and vasopressor support with a RR=27.9 (95% CI=1.0-749.9, p<0.05). No significant differences in the days of mechanical ventilation or mortality in both groups. The major mortality-associated risk factor in patients with pneumonia was a low Glasgow score at admittance with an OR=2.19 (95% CI 1.03 - 4.65), p<0.05.
Conclusions. The incidence of pneumonia in patients with severe brain trauma is high; however, its appearance does not affect the prognosis. The single significant risk factor was the presence of hypotension and vasopressor support.
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References
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13. Baker AM, Meredith JW, Haponik EF. Pneumonia in intubated trauma patients. Microbiology and outcomes. Am J Respir Crit Care Med. 1996;153:343-9.
14. Rello J, Kollef M, Díaz E, Sandiunmengue A, del Castillo Y, Corbella X, et al. Reduced burden of bacterial airway colonization with a novel silver-coated endotracheal tube in a randomized multiple-center feasibility study. Crit Care Med. 2006;34:2766-72.
15. Koeman M, van del Ven AJ, Hak E, Joore HC, Kaasjager K, de Smet AC, et al. Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med. 2006;173:1348-55.
16. Kollef MH, Skubas NJ, Sundt TM. A randomized clinical trial of continuous aspiration of subglottic secretions in cardiac surgery patients. Chest. 1999;116:1339-46.
17. Zygun DA, Zuege DJ, Boiteau PJ, Laupland KB, Henderson EA, Kortbeek JB, et al. Ventilator-associated pneumonia in severe traumatic brain injury. Neurocrit Care. 2006;5:108-14.
18. Sauaia A, Moore FA, Moore EE, Haenel JB, Read RA. Pneumonia related multiple organ failure is not a primary cause of death in head trauma. Pan Am J Trauma. 1992;3:90-9
2. Heyland DK, Cook DJ, Griffith L, Keenan SP, Brun-Buisson C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group. Am J Respir Crit Care Med. 1999;159:1249-56.
3. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165:867-903.
4. Papazian L, Bregeon F, Thirion X, Gregoire R, Saux P, Denis JP, et al. Effect of ventilator-associated pneumonia on mortality and morbidity. Am J Respir Crit Care Med. 1996;154:91-7.
5. Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002;122:2115–21.
6. Cavalcanti M, Ferrer M, Ferrer R, Morforte R, Garnacho A, Torres A. Risk and prognostic factors of ventilator-associated pneumonia in trauma patients. Crit Care Med. 2006;34:1067-72.
7. Leone M, Delliaux S, Bourgoin A, Albanese J, Garniere F, Bojadjiev I, et al. Risk factors for late-onset ventilator-associated pneumonia in trauma patients receiving selective digestive decontamination. Intensive Care Med. 2005;31:64-70.
8. Ewig S, Torres A, El-Ebiari M, Fabregas M, Hernández C, González J, et al. Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury. Am J Respir Crit Care Med. 1999;159:188-98.
9. Rincón-Ferrari MD, Flores-Cordero JM, Leal-Noval SR, Murillo-Cabezas M, Cayuelas A, Muñoz-Sánchez MA, et al. Impact of ventilator-associated pneumonia in patients with severe head injury. J Trauma. 2004;57:234-40.
10. Leone M, Bourgoin A, Giuly E, Antonini F, Dubuc M, Vivand X, et al. Influence on outcome of ventilator-associated pneumonia in multiple trauma patients with head trauma treated with selected digestive decontamination. Crit Care Med. 2002;30:1741-6.
11. Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000;118:146-55.
12. McDermott FT, Rosenfeld JV, Laidlaw JD, Cordner SM, Tremayne AB, Consultative Committee on Road Traffic Fatalities in Victoria. Evaluation of management of road trauma survivors with brain injury and neurologic disability in Victoria. J Trauma. 2004;56:137-49.
13. Baker AM, Meredith JW, Haponik EF. Pneumonia in intubated trauma patients. Microbiology and outcomes. Am J Respir Crit Care Med. 1996;153:343-9.
14. Rello J, Kollef M, Díaz E, Sandiunmengue A, del Castillo Y, Corbella X, et al. Reduced burden of bacterial airway colonization with a novel silver-coated endotracheal tube in a randomized multiple-center feasibility study. Crit Care Med. 2006;34:2766-72.
15. Koeman M, van del Ven AJ, Hak E, Joore HC, Kaasjager K, de Smet AC, et al. Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med. 2006;173:1348-55.
16. Kollef MH, Skubas NJ, Sundt TM. A randomized clinical trial of continuous aspiration of subglottic secretions in cardiac surgery patients. Chest. 1999;116:1339-46.
17. Zygun DA, Zuege DJ, Boiteau PJ, Laupland KB, Henderson EA, Kortbeek JB, et al. Ventilator-associated pneumonia in severe traumatic brain injury. Neurocrit Care. 2006;5:108-14.
18. Sauaia A, Moore FA, Moore EE, Haenel JB, Read RA. Pneumonia related multiple organ failure is not a primary cause of death in head trauma. Pan Am J Trauma. 1992;3:90-9
How to Cite
1.
Yepes D, Molina F, Ortiz G, Aguirre R. Risk factors associated with the presence of pneumonia in patients with brain injury. biomedica [Internet]. 2009 Jun. 1 [cited 2024 May 18];29(2):253-9. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/27
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