Severe traumatic brain injury and hospital acquired pneumonia: A study of correlation factors

Abstract

Objective To investigate the incidence and risk factors of hospital acquired pneumonia (HAP) among patients with severe traumatic brain injury (TBI). Methods The clinical and imaging data of 114 adult patients diagnosed as severe TBI were retrospectively reviewed who underwent treatment at Department of Neurosurgery, Beijing Tiantan Hospital, from March 2016 to March 2017. Factors analyzed included the age, gender, mechanisms of injury, CT scan before admission, GCS (Glasgow Coma Scale) scores, pupil changes, tracheal intubation or tracheostomy, central nervous system (CNS) infection, duration of mechanical ventilation and antibiotic drug use. Comparison of variables between groups with tracheal intubation and tracheostomy, early and late tracheostomy were conducted. Results The incidence of HAP after admission was 23.8%. Past history of pulmonary diseases, tracheal manipulation, CNS infection, diffuse axonal injury were considered as risk factors of HAP. Patients in tracheal intubation group had significantly fewer days of ventilator use and shorter stay at hospital, lower incidence of HAP compared with tracheostomy group. Patients with early tracheostomy had lower incidence of skull fracture, shorter hospital stay and less expenses, while their incidence of HAP and outcomes were not significantly different from those with late tracheostomy. Conclusions Pulmonary diseases, related tracheal manipulation, CNS infection and diffuse axonal injury could be the risk factors for HAP in patients with severe TBI. Early tracheostomy might not reduce the risk of HAP, while it could significantly decrease the incidence of skull fracture, the length of hospital stay, antibiotic usage and medical expenses. Key words: Craniocerebral trauma; Pneumonia, ventilator-associated; Root cause analysis