Abstract
IntroductionHypothermia may improve outcome in patients after traumatic brain injury, especially when hypothermia is maintained for more than 48 hours. In the acute phase, patients with severe brain injury are more vulnerable to infections. Prolonged hypothermic treatment may further enhance the risk of infection. Selective decontamination of the digestive tract (SDD) reduces the risk of respiratory tract infections. The aim of this study was to investigate the incidence of infections in patients treated with hypothermia and normothermia while receiving SDD.MethodsIn this retrospective case control study 35 patients treated with prolonged hypothermia (cases) were identified and 169 patients with severe brain injury were included (controls). Propensity score matching was performed to correct for differences in baseline characteristics and clinical parameters. Primary outcome was the incidence of infection. The secondary endpoints were the micro-organisms found in the surveillance cultures and infection. In addition, a number of clinical characteristics were assessed.ResultsThe demographic and clinical data indicated that the cases and controls were well matched. The overall risk of infection during ICU stay was 20% in the hypothermia groups versus 34.4% in the normothermia group (P = 0.388). Pneumonia was diagnosed in 11.4% of patients in both groups (P = 1.000). The incidence of meningitis, wound infection, bacteremia, and urinary tract infection was low and comparable between the groups. SDD surveillance cultures indicated a higher colonization with gram-negative bacteria in the rectal samples of the hypothermia patients.ConclusionsHypothermia does not increase the risk of infection in patients treated with SDD.
Highlights
Hypothermia may improve outcome in patients after traumatic brain injury, especially when hypothermia is maintained for more than 48 hours
The aim of this study was to compare the incidence of infection in patients with severe brain injury treated with prolonged mild therapeutic hypothermia while receiving Selective decontamination of the digestive tract (SDD) with normothermic control patients
No differences were found in the distribution of gram-negative bacteria between the groups
Summary
Hypothermia may improve outcome in patients after traumatic brain injury, especially when hypothermia is maintained for more than 48 hours. The aim of this study was to investigate the incidence of infections in patients treated with hypothermia and normothermia while receiving SDD. Hypothermia effectively lowers intracranial pressure and may improve neurological outcome and mortality in patients after traumatic brain injury, especially when hypothermia is maintained for more than 48 hours [1,2,3]. We hypothesized that the use of SDD in patients treated with mild hypothermia mitigates the earlier mentioned increased risk of infection. The aim of this study was to compare the incidence of infection in patients with severe brain injury treated with prolonged mild therapeutic hypothermia while receiving SDD with normothermic control patients
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