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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

Cumulative incidence function curve for VAP occurrence according to fever control protocol management. The non-parametric estimator according to Nelson-Aalen. VAP: ventilator-associated pneumonia.
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Fig3: Cumulative incidence function curve for VAP occurrence according to fever control protocol management. The non-parametric estimator according to Nelson-Aalen. VAP: ventilator-associated pneumonia.

Mentions: In the univariate analysis (Table 4), the patients who developed VAP were significantly younger, used tobacco more frequently and had more extensive lung injury at admission to the ICU. Application of the fever control protocol was a major risk factor for developing VAP (HR 3.06; 95% CI (1.58, 5.94)). In the multivariate analysis, the competing risk model was built after adjustment of the HR for a history of smoking, age, the SAPS II score, pentothal use and the use of neuromuscular blocker agents. The use of the fever control protocol was the only significant independent risk factor for VAP occurrence (HR 2.73, 95% CI (1.38, 5.38)) (Table 4). The cumulative incidence function curves for VAP are displayed in Figure 3. The risk of VAP appeared to be higher when the duration of the fever control protocol was >3 days (Figure 4).Table 4


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)

Cumulative incidence function curve for VAP occurrence according to fever control protocol management. The non-parametric estimator according to Nelson-Aalen. VAP: ventilator-associated pneumonia.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Cumulative incidence function curve for VAP occurrence according to fever control protocol management. The non-parametric estimator according to Nelson-Aalen. VAP: ventilator-associated pneumonia.
Mentions: In the univariate analysis (Table 4), the patients who developed VAP were significantly younger, used tobacco more frequently and had more extensive lung injury at admission to the ICU. Application of the fever control protocol was a major risk factor for developing VAP (HR 3.06; 95% CI (1.58, 5.94)). In the multivariate analysis, the competing risk model was built after adjustment of the HR for a history of smoking, age, the SAPS II score, pentothal use and the use of neuromuscular blocker agents. The use of the fever control protocol was the only significant independent risk factor for VAP occurrence (HR 2.73, 95% CI (1.38, 5.38)) (Table 4). The cumulative incidence function curves for VAP are displayed in Figure 3. The risk of VAP appeared to be higher when the duration of the fever control protocol was >3 days (Figure 4).Table 4

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