Effect of a fever control protocol-based strategy on ventilator-associated pneumonia in severely brain-injured patients
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- 作者：Yoann Launey (1) (2) (3)
Nicolas Nesseler (1) (2) (3)
Audren Le Cousin (1) (3)
Fanny Feuillet (4)
Ronan Garlantezec (5)
Yannick Mall茅dant (1) (2) (3)
Philippe Seguin (1) (2) (3)
1. CHU de Rennes. H么pital Pontchaillou. P么le Anesth茅sie-SAMU-Urgences-R茅animations. 2 ; rue Henri Le Guilloux ; 35033 ; Rennes ; Cedex ; France
2. Inserm UMR991 ; 茅quipe 2 ; 鈥淪tress ; Defense and Regeneration鈥? 2 ; rue Henri Le Guilloux ; 35000 ; Rennes ; France
3. Universit茅 Rennes 1 ; 35033 ; Rennes ; Cedex ; France
4. Plateforme de Biom茅trie 鈥?Cellule de promotion 脿 la recherche clinique ; CHU Nantes ; EA 4275 SPHERE 鈥淏iostatistics ; Pharmacoepidemiology & Human Sciences Research鈥? UFR de Pharmacie ; Universit茅 de Nantes. 1 ; rue Gaston Veil ; 44000 ; Nantes ; France
5. Ecole Nationale Hautes Etudes de Sant茅 Publique. 2 ; Avenue du Professeur L茅on Bernard ; 35033 ; Rennes ; Cedex ; France - 刊名：Critical Care
- 出版年：2014
- 出版时间：December 2014
- 年：2014
- 卷：18
- 期：6
- 全文大小：1,000 KB
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- 出版者：BioMed Central
- ISSN：1364-8535
文摘
Introduction Fever is associated with a poor outcome in severely brain-injured patients, and its control is one of the therapies used in this condition. But, fever suppression may promote infection, and severely brain-injured patients are frequently exposed to infectious diseases, particularly ventilator-associated pneumonia (VAP). Therefore, we designed a study to explore the role of a fever control protocol in VAP development during neuro-intensive care. Methods An observational study was performed on severely brain-injured patients hospitalized in a university ICU. The primary goal was to assess whether fever control was a risk factor for VAP in a prospective cohort in which a fever control protocol was applied and in a historical control group. Moreover, the density of VAP incidence was compared between the two groups. The statistical analysis was based on a competing risk model multivariate analysis. Results The study included 189 brain-injured patients (intervention group, n鈥?鈥?8, and historical control group, n鈥?鈥?1). The use of a fever control protocol was an independent risk factor for VAP (hazard ratio 2.73, 95% confidence interval (1.38, 5.38; P鈥?鈥?.005)). There was a significant increase in the incidence of VAP in patients treated with a fever control protocol (26.1 versus 12.5 VAP cases per 1000聽days of mechanical ventilation). In cases in which a fever control protocol was applied for >3聽days, we observed a higher rate of VAP in comparison with the rate among patients treated for 鈮?聽days. Conclusions Fever control in brain-injured patients was a major risk factor for VAP occurrence, particularly when applied for >3聽days.