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.