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Effect of a fever control protocol-based strategy on ventilator-associated pneumonia in severely brain-injured patients.

Launey Y, Nesseler N, Le Cousin A, Feuillet F, Garlantezec R, Mallédant Y, Seguin P - Crit Care (2014)

Bottom Line: Fever is associated with a poor outcome in severely brain-injured patients, and its control is one of the therapies used in this condition.Moreover, the density of VAP incidence was compared between the two groups.Fever control in brain-injured patients was a major risk factor for VAP occurrence, particularly when applied for > 3 days.

View Article: PubMed Central - PubMed

Affiliation: CHU de Rennes. Hôpital Pontchaillou. Pôle Anesthésie-SAMU-Urgences-Réanimations. 2, rue Henri Le Guilloux, 35033, Rennes, Cedex, France. yoann.launey@chu-rennes.fr.

ABSTRACT

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 = 98, and historical control group, n = 91). 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 = 0.005)). 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 days of mechanical ventilation). In cases in which a fever control protocol was applied for > 3 days, we observed a higher rate of VAP in comparison with the rate among patients treated for ≤ 3 days.

Conclusions: Fever control in brain-injured patients was a major risk factor for VAP occurrence, particularly when applied for > 3 days.

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Related in: MedlinePlus

Flowchart of the study inclusion scheme. MV: mechanical ventilation.
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Fig1: Flowchart of the study inclusion scheme. MV: mechanical ventilation.

Mentions: During the study period, 331 brain-injured patients were screened, and 189 were included (intervention group, n = 98; historical control group, n = 91) (Figure 1). The primary characteristics of the patients are presented in Table 1. The proportion of subarachnoid hemorrhaging was significantly higher in the intervention group than in the historical control group (28% versus 14%, respectively; P = 0.006). The clinical characteristics are reported in Table 2.Figure 1


Effect of a fever control protocol-based strategy on ventilator-associated pneumonia in severely brain-injured patients.

Launey Y, Nesseler N, Le Cousin A, Feuillet F, Garlantezec R, Mallédant Y, Seguin P - Crit Care (2014)

Flowchart of the study inclusion scheme. MV: mechanical ventilation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4279880&req=5

Fig1: Flowchart of the study inclusion scheme. MV: mechanical ventilation.
Mentions: During the study period, 331 brain-injured patients were screened, and 189 were included (intervention group, n = 98; historical control group, n = 91) (Figure 1). The primary characteristics of the patients are presented in Table 1. The proportion of subarachnoid hemorrhaging was significantly higher in the intervention group than in the historical control group (28% versus 14%, respectively; P = 0.006). The clinical characteristics are reported in Table 2.Figure 1

Bottom Line: Fever is associated with a poor outcome in severely brain-injured patients, and its control is one of the therapies used in this condition.Moreover, the density of VAP incidence was compared between the two groups.Fever control in brain-injured patients was a major risk factor for VAP occurrence, particularly when applied for > 3 days.

View Article: PubMed Central - PubMed

Affiliation: CHU de Rennes. Hôpital Pontchaillou. Pôle Anesthésie-SAMU-Urgences-Réanimations. 2, rue Henri Le Guilloux, 35033, Rennes, Cedex, France. yoann.launey@chu-rennes.fr.

ABSTRACT

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 = 98, and historical control group, n = 91). 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 = 0.005)). 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 days of mechanical ventilation). In cases in which a fever control protocol was applied for > 3 days, we observed a higher rate of VAP in comparison with the rate among patients treated for ≤ 3 days.

Conclusions: Fever control in brain-injured patients was a major risk factor for VAP occurrence, particularly when applied for > 3 days.

Show MeSH
Related in: MedlinePlus