Zygun David A, Zuege Danny J, Boiteau Paul J E, Laupland Kevin B, Henderson Elizabeth A, Kortbeek John B, Doig Christopher J
Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
Neurocrit Care. 2006;5(2):108-14. doi: 10.1385/ncc:5:2:108.
Pneumonia is an important cause of morbidity following severe traumatic brain injury (TBI). However, previous studies have been limited by inclusion of specific patient subgroups or by selection bias. The primary objective of this study was to describe the incidence, risk factors for, and outcome of ventilator-associated pneumonia in an unselected population-based cohort of patients with severe TBI. An additional goal was to define the relationship of ventilator-associated pneumonia (VAP) with nonneurological organ dysfunction.
A prospective, observational cohort study was performed at Foothills Medical Centre, the sole adult tertiary-care trauma center servicing southern Alberta. All patients with severe TBI requiring ventilation for more than 48 hours between May 1, 2000 and December 30, 2002 were included.
A total of 60 patients (45%) acquired VAP for an incidence density of 42.7/1000 ventilator days. Patients with polytrauma were at higher risk (risk ratio 1.7, 95% confidence interval, 0.9-3.1) for development of VAP than those with isolated head injury. Development of VAP was associated with a significantly greater degree of nonneurological organ system dysfunction. Although VAP was not associated with increased hospital mortality, patients who developed VAP had a longer duration of mechanical ventilation (15 versus 8 days, p < 0.0001), longer intensive care unit (17 versus 9 days, p < 0.0001) and hospital (60 versus 28 days, p = 0.003) lengths of stay, and more often required tracheostomy (35 versus 18%, p = 0.003).
VAP occurs frequently and is associated with significant morbidity in patients with severe TBI.
肺炎是重度创伤性脑损伤（TBI）后发病的重要原因。然而，既往研究因纳入特定患者亚组或存在选择偏倚而受到限制。本研究的主要目的是描述在一个未选择的基于人群的重度TBI患者队列中呼吸机相关性肺炎的发病率、危险因素及结局。另一个目标是明确呼吸机相关性肺炎（VAP）与非神经器官功能障碍之间的关系。
在山麓医疗中心进行了一项前瞻性观察性队列研究，该中心是为艾伯塔省南部提供服务的唯一一家成人三级创伤中心。纳入2000年5月1日至2002年12月30日期间所有因重度TBI需要机械通气超过48小时的患者。
共有60例患者（45%）发生VAP，发病密度为42.7/1000呼吸机日。多发伤患者发生VAP的风险（风险比1.7，95%置信区间，0.9 - 3.1）高于单纯颅脑损伤患者。VAP的发生与非神经器官系统功能障碍程度显著加重相关。虽然VAP与医院死亡率增加无关，但发生VAP的患者机械通气时间更长（15天对8天，p < 0.0001），重症监护病房住院时间更长（17天对9天，p < 0.0001），住院时间更长（60天对28天，p = 0.003），且更常需要气管切开（35%对18%，p = 0.003）。
VAP在重度TBI患者中频繁发生且与显著的发病率相关。
