PMID- 32634435 OWN - NLM STAT- MEDLINE DCOM- 20210525 LR - 20210525 IS - 1931-3543 (Electronic) IS - 0012-3692 (Linking) VI - 158 IP - 6 DP - 2020 Dec TI - 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. PG - 2292-2303 LID - S0012-3692(20)31866-3 [pii] LID - 10.1016/j.chest.2020.06.064 [doi] AB - 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. CI - Copyright (c) 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. FAU - Robba, Chiara AU - Robba C AD - Department of Anesthesia and Intensive Care Policlinico San Martino IRCCS for Oncology and Neuroscience, Genova. FAU - Rebora, Paola AU - Rebora P AD - School of Medicine and Surgery, University of Milan-Bicocca, Milan; Center for Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza. FAU - Banzato, Erika AU - Banzato E AD - Center for Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza; Department of Statistical Sciences, University of Padova, Padua. FAU - Wiegers, Eveline J A AU - Wiegers EJA AD - Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. FAU - Stocchetti, Nino AU - Stocchetti N AD - Department of Physiopathology and Transplantation, Milan University, and Neuroscience ICU, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy. FAU - Menon, David K AU - Menon DK AD - Department of Anesthesia, University of Cambridge, Cambridge, England. FAU - Citerio, Giuseppe AU - Citerio G AD - School of Medicine and Surgery, University of Milan-Bicocca, Milan. Electronic address: giuseppe.citerio@unimib.it. CN - Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Participants and Investigators LA - eng SI - ClinicalTrials.gov/NCT02210221 PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20200704 PL - United States TA - Chest JT - Chest JID - 0231335 SB - IM MH - Adult MH - Aged MH - Brain Injuries, Traumatic/*complications/diagnosis/therapy MH - Europe/epidemiology MH - Female MH - Follow-Up Studies MH - Humans MH - Incidence MH - Injury Severity Score MH - Intensive Care Units/*statistics & numerical data MH - Male MH - Middle Aged MH - Pneumonia, Ventilator-Associated/epidemiology/*etiology MH - Prognosis MH - Prospective Studies MH - Respiration, Artificial/*adverse effects MH - Risk Assessment/*methods MH - Risk Factors MH - Survival Rate/trends MH - Tomography, X-Ray Computed OTO - NOTNLM OT - mechanical ventilation OT - outcome OT - oxygenation OT - traumatic brain injury OT - ventilator-associated pneumonia FIR - Akerlund, Cecilia IR - Akerlund C FIR - Nelson, David IR - Nelson D FIR - Amrein, Krisztina IR - Amrein K FIR - Nyiradi, Jozsef IR - Nyiradi J FIR - Andelic, Nada IR - Andelic N FIR - Andreassen, Lasse IR - Andreassen L FIR - Anke, Audny IR - Anke A FIR - Audibert, Gerard IR - Audibert G FIR - Azouvi, Philippe IR - Azouvi P FIR - Azzolini, Maria Luisa IR - Azzolini ML FIR - Beretta, Luigi IR - Beretta L FIR - Calvi, Maria Rosa IR - Calvi MR FIR - Bartels, Ronald IR - Bartels R FIR - Boogert, Hugo den IR - Boogert HD FIR - Beer, Ronny IR - Beer R FIR - Helbok, Raimund IR - Helbok R FIR - Bellander, Bo-Michael IR - Bellander BM FIR - Benali, Habib IR - Benali H FIR - Degos, Vincent IR - Degos V FIR - Galanaud, Damien IR - Galanaud D FIR - Perlbarg, Vincent IR - Perlbarg V FIR - Vanhaudenhuyse, Audrey IR - Vanhaudenhuyse A FIR - Berardino, Maurizio IR - Berardino M FIR - Blaabjerg, Morten IR - Blaabjerg M FIR - Lund, Stine Borgen IR - Lund SB FIR - Brorsson, Camilla IR - Brorsson C FIR - Buki, Andras IR - Buki A FIR - Czeiter, Endre IR - Czeiter E FIR - Cabeleira, Manuel IR - Cabeleira M FIR - Czosnyka, Marek IR - Czosnyka M FIR - Smielewski, Peter IR - Smielewski P FIR - Caccioppola, Alessio IR - Caccioppola A FIR - Calappi, Emiliana IR - Calappi E FIR - Carbonara, Marco IR - Carbonara M FIR - Mulazzi, Davide IR - Mulazzi D FIR - Ortolano, Fabrizio IR - Ortolano F FIR - Zoerle, Tommaso IR - Zoerle T FIR - Cameron, Peter IR - Cameron P FIR - Gantner, Dashiell IR - Gantner D FIR - Murray, Lynnette IR - Murray L FIR - Trapani, Tony IR - Trapani T FIR - Vallance, Shirley IR - Vallance S FIR - Lozano, Guillermo Carbayo IR - Lozano GC FIR - Pomposo, Inigo IR - Pomposo I FIR - Castano-Leon, Ana M IR - Castano-Leon AM FIR - Gomez, Pedro A IR - Gomez PA FIR - Lagares, Alfonso IR - Lagares A FIR - Chevallard, Giorgio IR - Chevallard G FIR - Chieregato, Arturo IR - Chieregato A FIR - Citerio, Giuseppe IR - Citerio G FIR - Coburn, Mark IR - Coburn M FIR - Kowark, Ana IR - Kowark A FIR - Rossaint, Rolf IR - Rossaint R FIR - Coles, Jonathan IR - Coles J FIR - Cooper, Jamie D IR - Cooper JD FIR - Correia, Marta IR - Correia M FIR - Dahyot-Fizelier, Claire IR - Dahyot-Fizelier C FIR - De Keyser, Veronique IR - De Keyser V FIR - Maas, Andrew I R IR - Maas AIR FIR - Menovsky, Tomas IR - Menovsky T FIR - Nair, Nandesh IR - Nair N FIR - Van der Steen, Gregory IR - Van der Steen G FIR - Della Corte, Francesco IR - Della Corte F FIR - Grossi, Francesca IR - Grossi F FIR - Depreitere, Bart IR - Depreitere B FIR - Dilvesi, Dula IR - Dilvesi D FIR - Golubovic, Jagos IR - Golubovic J FIR - Karan, Mladen IR - Karan M FIR - Vulekovic, Petar IR - Vulekovic P FIR - Dixit, Abhishek IR - Dixit A FIR - Ercole, Ari IR - Ercole A FIR - Koraropoulos, Evgenios IR - Koraropoulos E FIR - Menon, David IR - Menon D FIR - Newcombe, Virginia IR - Newcombe V FIR - Richter, Sophie IR - Richter S FIR - Stamatakis, Emmanuel IR - Stamatakis E FIR - Williams, Guy IR - Williams G FIR - Winzeck, Stefan IR - Winzeck S FIR - Zeiler, Frederik A IR - Zeiler FA FIR - Dreier, Jens IR - Dreier J FIR - Duliere, Guy-Loup IR - Duliere GL FIR - Marechal, Hugues IR - Marechal H FIR - Ezer, Erzsebet IR - Ezer E FIR - Vamos, Zoltan IR - Vamos Z FIR - Fabricius, Martin IR - Fabricius M FIR - Kondziella, Daniel IR - Kondziella D FIR - Foks, Kelly IR - Foks K FIR - Frisvold, Shirin IR - Frisvold S FIR - Furmanov, Alex IR - Furmanov A FIR - Rosenthal, Guy IR - Rosenthal G FIR - Ghuysen, Alexandre IR - Ghuysen A FIR - Giga, Lelde IR - Giga L FIR - Valeinis, Egils IR - Valeinis E FIR - Ziverte, Agate IR - Ziverte A FIR - Gupta, Deepak IR - Gupta D FIR - Haitsma, Iain IR - Haitsma I FIR - Volovici, Victor IR - Volovici V FIR - Helseth, Eirik IR - Helseth E FIR - Hutchinson, Peter J IR - Hutchinson PJ FIR - Kolias, Angelos G IR - Kolias AG FIR - Jankowski, Stefan IR - Jankowski S FIR - Koskinen, Lars-Owe IR - Koskinen LO FIR - Kovacs, Noemi IR - Kovacs N FIR - Laureys, Steven IR - Laureys S FIR - Noirhomme, Quentin IR - Noirhomme Q FIR - Vanhaudenhuyse, Audrey IR - Vanhaudenhuyse A FIR - Lejeune, Aurelie IR - Lejeune A FIR - Vega, Emmanuel IR - Vega E FIR - Lightfoot, Roger IR - Lightfoot R FIR - Steyerberg, Ewout W IR - Steyerberg EW FIR - Lingsma, Hester IR - Lingsma H FIR - Voormolen, Daphne IR - Voormolen D FIR - Manara, Alex IR - Manara A FIR - Thomas, Matt IR - Thomas M FIR - Martino, Costanza IR - Martino C FIR - Mattern, Julia IR - Mattern J FIR - Sakowitz, Oliver IR - Sakowitz O FIR - Younsi, Alexander IR - Younsi A FIR - McMahon, Catherine IR - McMahon C FIR - Muraleedharan, Visakh IR - Muraleedharan V FIR - Negru, Ancuta IR - Negru A FIR - Ples, Horia IR - Ples H FIR - Tudora, Cristina Maria IR - Tudora CM FIR - Payen, Jean-Francois IR - Payen JF FIR - Persona, Paolo IR - Persona P FIR - Rossi, Sandra IR - Rossi S FIR - Peul, Wilco IR - Peul W FIR - van Dijck, Jeroen T J M IR - van Dijck JTJM FIR - van Essen, Thomas A IR - van Essen TA FIR - van Wijk, Roel P J IR - van Wijk RPJ FIR - Piippo-Karjalainen, Anna IR - Piippo-Karjalainen A FIR - Raj, Rahul IR - Raj R FIR - Posti, Jussi P IR - Posti JP FIR - Tenovuo, Olli IR - Tenovuo O FIR - Puybasset, Louis IR - Puybasset L FIR - Radoi, Andreea IR - Radoi A FIR - Sahuquillo, Juan IR - Sahuquillo J FIR - Ragauskas, Arminas IR - Ragauskas A FIR - Rocka, Saulius IR - Rocka S FIR - Rhodes, Jonathan IR - Rhodes J FIR - Roe, Cecilie IR - Roe C FIR - Roise, Olav IR - Roise O FIR - Rosenfeld, Jeffrey V IR - Rosenfeld JV FIR - Rosenlund, Christina IR - Rosenlund C FIR - Sandro, Oddrun IR - Sandro O FIR - Schirmer-Mikalsen, Kari IR - Schirmer-Mikalsen K FIR - Sakowitz, Oliver IR - Sakowitz O FIR - Sanchez-Porras, Renan IR - Sanchez-Porras R FIR - Schirmer-Mikalsen, Kari IR - Schirmer-Mikalsen K FIR - Vik, Anne IR - Vik A FIR - Schou, Rico Frederik IR - Schou RF FIR - Sorinola, Abayomi IR - Sorinola A FIR - Tamas, Viktoria IR - Tamas V FIR - Steyerberg, Ewout W IR - Steyerberg EW FIR - Stocchetti, Nino IR - Stocchetti N FIR - Sundstrom, Nina IR - Sundstrom N FIR - Takala, Riikka IR - Takala R FIR - Tamosuitis, Tomas IR - Tamosuitis T FIR - Tibboel, Dick IR - Tibboel D FIR - Tolias, Christos IR - Tolias C FIR - Vajkoczy, Peter IR - Vajkoczy P FIR - Vargiolu, Alessia IR - Vargiolu A FIR - Vik, Anne IR - Vik A FIR - Vilcinis, Rimantas IR - Vilcinis R FIR - Wolf, Stefan IR - Wolf S FIR - Zeiler, Frederik A IR - Zeiler FA EDAT- 2020/07/08 06:00 MHDA- 2021/05/26 06:00 CRDT- 2020/07/08 06:00 PHST- 2020/01/15 00:00 [received] PHST- 2020/05/27 00:00 [revised] PHST- 2020/06/08 00:00 [accepted] PHST- 2020/07/08 06:00 [pubmed] PHST- 2021/05/26 06:00 [medline] PHST- 2020/07/08 06:00 [entrez] AID - S0012-3692(20)31866-3 [pii] AID - 10.1016/j.chest.2020.06.064 [doi] PST - ppublish SO - Chest. 2020 Dec;158(6):2292-2303. doi: 10.1016/j.chest.2020.06.064. Epub 2020 Jul 4.