A Study of Incidence and Correlational Factors and Comparison of Effects of Ventilator-Associated Pneumonia in Young and Adolescent Brain Trauma Patients
Objective: To study the incidence of ventilator-associated pneumonia (VAP) in young and adolescent brain trauma patients, with an emphasis on its correlational factors and a comparison of its effects
Design: Descriptive retrospective analysis research
Methodology: The sample consisted of 121 purposively sampled young and adolescent brain trauma patients who were on operating ventilators for at least 48 hours as they were treated in the intensive care unit of a tertiary hospital in Northeastern Thailand between 1 January 2015 and 31 December 2019. Data were collected from medical records, using data-gathering forms. The data were analysed using 1) incidence rate computation; 2) descriptive statistics (for demographic data); 3) inferential statistics (for VAP effects); and 4) multiple correlational logistic regression analysis.
Results: Of the 121 patients, there were 45 VAP patients (59 episodes). The VAP incidence rate was 37.19 or 46.83 episodes per 1,000 ventilator days. The three most common pathogens of VAP were Acinetobacter baumannii (44.08%), Klebsiella pneumonia (25.42%), and Pseudomonas aeruginosa (16.95%). Factors associated with VAP in the young and adolescent brain trauma patients were the use of cooling blankets (OR Adj 7.39; 95% CI = 2.60, 21.02; p < .001) and continuous intravenous administration of fentanyl (OR Adj 12.28; 95%CI = 4.04, 37.36; p < .001). A comparison of effects of VAP showed statistically signifcant differences between the patients with and without VAP. That is, the patients without VAP spent less time on ventilators (4 days VS 18 day; p < .001), shorter time in the intensive care unit (4 days VS 20 day; p < .001), fewer days of hospitalisation (8 days VS 28 day; p < .001), and lower hospitalisation costs (57,862.75 baht VS 183,202 baht; p < .001) than those with VAP. However, no statistically signifcant difference in the mortality rate was found between the two groups (4.44% VS 15.79%; p = .059).
Recommendations: Nurses and multidisciplinary team caring for young and adolescent brain trauma patients should pay close attention to factors associated with VAP, namely, the use of cooling blankets and continuous intravenous administration of fentanyl. Also, clinical nursing practice guidelines should be developed to prevent VAP in young and adolescent brain trauma patients. Further prospective studies on other VAP factors in young and adolescent brain trauma patients are recommended.
Kourbeti IS, Vakis AF, Papadakis JA, Karabetsos DA, Bertsias G, Filippou M, et al.Infections in traumatic brain injury patients. Clin Microbiol Infect 2012;18(4):359-64.
Torres N, Donohue M, Frizzola M. 1414: Risk factors associated with ventilator-associated pneumonia in pediatric traumatic brain injury. CriticalCare Medicine 2019;47(1):p683.
Alharf IM, Charyk Stewart T, Al Helali I, Daoud H, Fraser DD. Infection rates, fevers, and associated factors in pediatric severe traumatic brain injury. J Neurotrauma 2014;31(5):452-8.
Hamele M, Stockmann C, Cirulis M, Riva-Cambrin J, Metzger R, Bennett TD, et al. Ventilatorassociated pneumonia in pediatric traumatic brain injury. J Neurotrauma 2016;33(9):832-9
Taira BR, Fenton KE, Lee TK, Meng H, McCormack JE, Huang E, et al. Ventilator-associated pneumonia in pediatric trauma patients. Pediatr Crit Care Med 2009;10(4):491-4.
Li Y, Liu C, Xiao W, Song T, Wang S. Incidence, risk factors, and outcomes of ventilator-associated pneumonia in traumatic brain injury: a metaanalysis. Neurocrit Care 2020;32(1):272-85.
Cirulis MM, Hamele MT, Stockmann CR, Bennett TD, Bratton SL. Comparison of the new adult ventilator-associated event criteria to the Centers for Disease Control and Prevention pediatric ventilatorassociated pneumonia definition (PNU2) in a population of pediatric traumatic brain injury patients. Pediatr Crit Care Med 2016;17(2):157-64.
Ortega HW, Cutler G, Dreyfus J, Flood A, Kharbanda A. Hospital-acquired pneumonia among pediatric trauma patients treated at national trauma centers. J Trauma Acute Care Surg 2015;78(6):1149-54.
Zygun DA, Zuege DJ, Boiteau PJ, Laupland KB, Henderson EA, Kortbeek JB, et al. Ventilatorassociated pneumonia in severe traumatic brain injury. Neurocrit Care 2006;5(2):108-14.
Kallel H, Chelly H, Bahloul M, Ksibi H, Dammak H, ChaariA, et al. The effect of ventilator-associated pneumonia and the progress of head trauma patients. J Trauma 2005;59(3):705-10.
Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery 2017;80(1):6-15.
Adelson PD, Ragheb J, Kanev P, Brockmeyer D, Beers SR, Brown SD, et al. Phase II clinical trial of moderate hypothermia after severe traumatic brain injury in children. Neurosurgery 2005;56(4):740-54.
Fatima N, Ayyad A, Shuaib A, Saqqur M. Hypertonic solutions in traumatic brain injury: a systematic review and meta-analysis. Asian J Neurosurg 2019;14(2):382-91.
Kolmodin L, Sekhon MS, Henderson WR, Turgeon AF, Griesdale DE. Hypernatremia in patients with severe traumatic brain injury: a systematic review. Ann Intensive Care 2013;3(1):35.
Jentzer JC, Coons JC, Link CB, Schmidhofer M. Pharmacotherapy update on the use of vasopressors and inotropes in the intensive care unit. J Cardiovasc Pharmacol Ther 2015;20(3):249-60.
Prangthong K, Piemsuwan V. Ventilator-associated pneumonia in pediatric respiratory care unit, Siriraj hospital. Thai J Pediatr 2011;50(1):50-7. (in Thai)
Inchan T, Duangpaeng S, Masingboon K, Effectiveness of the clinical practice guideline for prevention of ventilator associated pneumonia on incidence of pneumonia and duration of mechanical ventilation among traumatic brain injured patients.TJNC 2012;24(2):50-63. (in Thai)
Centers for Disease Control and Prevention. Guidelines for preventing health -careassociater pneumonia 2009. [cited March 5, 2020]. Available from http:// www.cdc.gov
Hosmer DW, Lemeshow S. Applied logistic regression. 2nd Edition. New York: John Wiley & Sons, Inc.; 2000.
Gadappa SM, Behera M K. Ventilator associated pneumonia: incidence, profle and outcome in pediatric intensive care unit of tertiary care centre. Int J Contemp Pediatr 2018;5(6):2098-102.
Vijay G, Mandal A, Sankar J, Kapil A, Lodha R, Kabra SK. Ventilator associated pneumonia in pediatric intensive care unit: incidence, risk factors and etiological agents. Indian J Pediatr 2018;85(10):861-6.
Galal YS, Youssef MR, Ibrahiem SK. Ventilatorassociated pneumonia: incidence, risk factors and outcome in paediatric intensive care units at Cairo university hospital. J Clin Diagn Res 2016;10(6):SC06-SC11.
Chawla R. Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilatorassociated pneumonia in Asian countries. Am J Infect Control 2008;36: S93-S100.
Sund-Levander M, Wahren LK. Assessment and prevention of shivering in patients with severe cerebral injury a pilot study. J Clin Nurs 2000;9(1):55-61.
Torrance HD, Brohi K, Pearse RM, Mein CA, Wozniak E, Prowle JR, et al. Association between gene expression biomarkers of immunosuppression and blood transfusion in severely injured polytrauma patients. Ann Surg 2015;26 (4):751-9.
Xu G, Hu B, Chen G, Yu X, Luo J, Lv J, et al. Analysis of blood trace elements and biochemical indexes levels in severe craniocerebral trauma adults with glasgow coma scale and injury severity score. Biol Trace Elem Res 2015;164(2):192-7
Copyright (c) 2020 Thai Journal of Nursing Council
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.