Influence and related influencing factors of artificical airway timing on pulmonary infection in patients with severe craniocerebral injury

Abstract

Objective To investigate the influence of artificial airway on pulmonary infection in patients with severe craniocerebral injury and the risk factors of pulmonary infection. Methods From January 2015 to December 2017, a total of 110 cases of severe craniocerebral injury with pulmonary infection were analyzed, retrospectively. According to the time of establishing artificial airway, the patients were divided into observation group (64 cases) and control group (46 cases). The incidence of pulmonary infection, the time of infection control, the fatality rate, and influencing factors of pulmonary infection in patients with severe craniocerebral injury were compared, and univariate analysis was carried out [sex, age, coma time, smoking history, chronic bstructive pulmonary diseases (COPD), GCS score for chronic obstructive pulmonary disease, time to establish artificial airway, time to use hormones, time to use antibiotics], and then multivariate Logistic regression analysis was carried out. Results The incidence of pulmonary infection in the observation group was significantly lower than that of the control group (40.63% vs. 60.87%; χ2 = 4.389, P = 0.036); the infection control rate was significantly higher than that of the control group (80.77% vs. 53.77%; χ2 = 4.488, P = 0.034); the control time of infection was significantly shorter than that of the control group [(7.06 ± 2.77) d vs. (11.12 ± 3.62) d; t = 3.815, P = 0.001]; the mortality was significantly lower than that of the control group (7.81% vs. 21.74%; χ2 = 4.408, P = 0.036), all with significant differences. Sex, time of hormone use and time of antimicrobial agents use had no significant effect on pulmonary infection of patients with severe craniocerebral injury, with no significant difference (χ2 = 0.294, P = 0.587; χ2 = 0.878, P = 0.349; χ2 = 0.572, P = 0.449). For patients with age > 60 years old, coma period > 1 week, smoking history, COPD, GCS score ≤ 5, artificial airway established 24 hours after injury, the pulmonary infection rate were significantly higher, with statistically significant differences (χ2 = 5.583, P = 0.018; χ2 = 7.328, P = 0.007; χ2 = 4.994, P = 0.025; χ2 = 4.878, P = 0.027; χ2 = 6.114, P = 0.013; χ2 = 4.389, P = 0.036). Multivariate Logistic analysis showed that, age > 60 years old, coma period > 1 week, complicated with COPD, GCS score ≤ 5, artificial airway established 24 hours after injury were all the risk factors of pulmonary infection in patients with severe craniocerebral injury (P = 0.024, 0.015, 0.019, 0.007, 0.011). Conclusion The establishment of artificial airway 24 hours after injury is a risk factor of pulmonary infection for patients with severe craniocerebral injury. Key words: Severe craniocerebral injury; Pulmonary infection; Artificial airway; Influencing factor