Volume 7 Supplement 2

23rd International Symposium on Intensive Care and Emergency Medicine

Open Access

Pulmonary infection in brain-injured patients

  • P Pelosi1,
  • G Apostolou1,
  • B Gomiero1,
  • S Cominotti1,
  • P Severgnini1,
  • E Lucchini1,
  • R Colombo1,
  • G LiBassi2 and
  • M Chiaranda1
Critical Care20037(Suppl 2):P141

https://doi.org/10.1186/cc2030

Published: 3 March 2003

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

-

 

Number of patients

GCS at entry

SIRS

Sepsis

Septic shock

SIRS + cathecol

BAL+

29

7.8 ± 3.7

0%

44.8%

55.1%

0%

BAL-

31

10.5 ± 3.8

48.4%

0%

0%

25.8%

P

 

< 0.05

< 0.01

< 0.01

< 0.01

< 0.01

Table 2

-

 

Altered chest X-ray

PaO2/FiO2 < 200

Secretions

Leucocyte count > 12,000 or < 4000

Temperature > 38°C or < 36°C

BAL+

96.5%

58.6%

89.6%

79.3%

86.2%

BAL-

3.2%

9.6%

51.6%

54.8%

25.8%

P

< 0.01

< 0.01

< 0.01

< 0.05

< 0.01

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.

Authors’ Affiliations

(1)
Department of Clinical and Biological Sciences, University of Insubria,Varese-Circolo and Fondazione Macchi Hospital
(2)
Institute of Anesthesia and Intensive Care, Policlinico Hospital – IRCCS

References

  1. Ewig S, et al.: Am J Respir Crit Care Med 1999, 159: 188-198.View ArticlePubMedGoogle Scholar
  2. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Crit Care Med 1992, 20: 864-874.Google Scholar

Copyright

© BioMed Central Ltd 2003