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Pulmonary infection in brain-injured patients

Background and goal of study

Brain-injured patients are characterized by an increased risk to develop respiratory failure due to pneumonia, incidence of which is estimated at around 30–50% [1]. The aim of this study was to analyze in brain-injured patients during mechanical ventilation: 1) the incidence of pulmonary infection (P.I.), diagnosed by cultural data of bronchoalveolar lavage (> 104 cfu/ml); 2) predisponent factors of P.I.; 3) the prevalence of sepsis and severe sepsis criteria [2]; 4) the association with morphological alterations of chest X-ray, respiratory failure (PaO2/FiO2 < 200 mmHg), presence of tracheobronchial secretions; 5) the association with leucocyte count and core temperature; 6) peripheral organ failure, evaluated by SOFA score.

Material and methods

In this study we prospectively analyzed 60 brain-injured patients (sex M/F, 40/20; age, 43 ± 20 years; BMI, 24.5 ± 2.7 kg/m2; trauma/not trauma, 23/37; GCS, 9 ± 3) during mechanical ventilation.

Results and discussion

Results are specified in Tables 1 and 2.

Table 1 -
Table 2 -

Conclusions

In brain-injured patients, during mechanical ventilation: 1) 48% of patients developed P.I.; 2) GCS at entry seems to be the principal risk factor of P.I.; 3) 48.4% of patients without P.I. developed signs of SIRS + cathecolamines need; 4) the chest X-ray of 96.5% of patients with P.I. was modified, associated with severe hypoxiemia in the 58% of cases; 5) 40–50% of patients without P.I. showed alterations of the leukocyte count and of the secretions; 6) peripheral organ failures (renal, cardiac, hepatic) are infrequent.

References

  1. Ewig S, et al.: Am J Respir Crit Care Med 1999, 159: 188-198.

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  2. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Crit Care Med 1992, 20: 864-874.

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Pelosi, P., Apostolou, G., Gomiero, B. et al. Pulmonary infection in brain-injured patients. Crit Care 7, P141 (2003). https://doi.org/10.1186/cc2030

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  • DOI: https://doi.org/10.1186/cc2030

Keywords

  • Public Health
  • Pneumonia
  • Mechanical Ventilation
  • Emergency Medicine
  • Respiratory Failure