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| Clinical characteristics and related factors of early-onset ventilator-associated pneumonia in patients with severe traumatic brain injury |
| Zhang Xi-qiang, He Duo-qi, Yun Hui-bin, Sun Yu, Wang Chun-mei |
| Department of Neurosurgery, the Third People′s Hospital of Xining City, Xining 810005, China |
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Abstract Objective To evaluate the incidence, related factors and clinical prognosis of early-onset ventilator-associated pneumonia (EOVAP) in severe traumatic brain injury(sTBI) patients. Methods The clinical data of 206 sTBI patients treated with nearosurgery ICU in the third peopl′s hospitat of xining city were selected. The patients were divided into EOVAP group and non-EOVAP group according to whether the patient developed EOVAP. The clinical data of two groups of patients was compared. Logistic regression analysis was used to evaluate the risk factors for EOVAP in patients. The effects of EOVAP on cerebral oxygenation and prognosis were evaluated. Results 125 (60.7%) patients with sTBI were diagnosed with EOVAP. The risk factors affecting patients with EOVAP were: mild hypothermia therapy (OR=3.486, 95%CI 1.211～10.035, P=0.026) and chest abbreviated injury scale(AIS)≥3(OR=2.429, 95% CI1.116～5.738, P=0.043), positive for endotracheal aspiration cultures (OR=4.225, 95%CI 1.717～10.601, P=0.003) and gastric contents inhalation (OR=5.258, 95%CI1.723～15.998, P=0.004). Preventive use of antibiotics was a protective factor for EOVAP (OR=0.313, 95%CI0.157～0.891, P=0.011). The Brain tissue oxygen tension and oxygenation in group EOVAP were significantly decreased (t=3.489, 17.584, P all<0.001). Multivariate logistic regression analysis showed that EOVAP was significantly associated with poor prognosis (OR=2.719, 95%CI 1.017～7.252, P=0.038). Conclusion The incidence of EOVAP in sTBI patients is higher. The major risk factors are mild hypothermia, severe thoracic lesions, and gastric contents inhalation. EOVAP has adverse effects on brain oxygenation in patients and is independently associated with poor 1-year prognosis. Therefore, clinicians should take all necessary measures to prevent the occurrence of EOVAP in patients with sTBI.
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| About author:: Zhang Xi-qiang, E-mail: zhangxiqiangnx@sohu.com |
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