Retrospective Analysis of the Risk Factors and Pathogens Associated With Early-onset Ventilator-associated Pneumonia in Surgical-ICU Head-trauma Patients

Abstract

We demonstrate for the first time that early enteral feeding is a protective factor for EOVAP, and this result could have clinical implications for the prevention of EOVAP after traumatic brain injury. This study also confirms that barbiturate use is an important risk factor of EOVAP whereas Methicillin-susceptible S. aureus was found to be the main pathogen involved in EOVAP.

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

“…This incidence was greater than typically observed in the medical literature. Indeed, others series showed an EOVAP incidence of 20-45% in patients with TBIs admitted to the ICU [5,6,8,28,29]. One potential explanation for this discrepancy might be related to the patients included in our study: we analyzed only patients with severe TBIs.…”

“…EOVAP is classically caused by antibiotic-susceptible pathogens [6,7]. It is currently well established that EOVAP has a deleterious impact on morbidity; it was associated with long mechanical ventilation times and prolonged hospital stays [6,8]. However, apparently, EOVAP was not associated with an increased risk of hospital mortality or a poor outcome [5,9].…”

RETRACTED CHAPTER: Brain Trauma and Nutritional Support

“…Early enteral nutrition after TBI has been shown to be a protective factor against the development of ventilator-associated pneumonia (Lepelletier et al 2010). Early beginning of enteral nutrition in patients with TBI reduces proteolysis, attenuates the systemic inflammatory response, improves immune competency, and reduces the risk of infections and bacterial translocation through the guts (Perel et al 2006;Taylor et al 1999).…”

Etomidate increases susceptibility to pneumonia in trauma patients

“…We hypothesized that etomidate may be an independent risk factor for HAP and therefore performed a multivariate analysis for the risk factors of HAP. Twentynine variables potentially associated with the occurrence of HAP in trauma patients [19,20] were tested by univariate analysis (Table 3). In the univariate analysis, HAP was associated (at p \ 0.25) with etomidate use, ISS, TBI and time from trauma to tracheal intubation ( Table 4).…”

“…The duration of MV was 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) days in the nonetomidate group and 13 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) days in the etomidate group (p = 0.275), and the ICU length of stay was 15 (9-28) days in the non-etomidate group and 16 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) days in the etomidate group (p = 0.422). Four (7.4 %) patients in the non-etomidate group and six (6 %) patients in the etomidate group died (p = 1).…”