Early-Onset Ventilator-Associated Pneumonia in Severe Traumatic Brain Injury: is There a Relationship with Prehospital Airway Management?

Lorenzo Gamberini; Aimone Giugni; Serena Ranieri; Tommaso Meconi; Carlo Coniglio; Giovanni Gordini; Tommaso Bardi

doi:10.1016/j.jemermed.2019.02.005

Early-Onset Ventilator-Associated Pneumonia in Severe Traumatic Brain Injury: is There a Relationship with Prehospital Airway Management?

J Emerg Med. 2019 Jun;56(6):657-665. doi: 10.1016/j.jemermed.2019.02.005. Epub 2019 Apr 15.

Authors

Lorenzo Gamberini¹, Aimone Giugni¹, Serena Ranieri², Tommaso Meconi², Carlo Coniglio¹, Giovanni Gordini¹, Tommaso Bardi¹

Affiliations

¹ Division of Anesthesia, Intensive Care, and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy.
² Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy.

PMID: 31000428
DOI: 10.1016/j.jemermed.2019.02.005

Abstract

Background: Prehospital airway management in severe traumatic brain injury (TBI) is widely recommended by international guidelines for the management of trauma. Early-onset ventilator-associated pneumonia (EOVAP) is a common occurrence in this population and can worsen mortality and functional outcome.

Objectives: In this retrospective observational study, we aimed to evaluate the association between different prehospital airway management variables and the occurrence of EOVAP. Secondarily we evaluated the correlation between EOVAP and mortality and neurological outcome.

Methods: The study retrospectively evaluated 223 patients admitted from 2010 to 2017 in our trauma intensive care unit for severe TBI. The population was divided into three groups on the basis of the airway management technique adopted (bag mask ventilation, laryngeal tube, orotracheal intubation). Uni- and multivariate logistic regression analyses were performed using the occurrence of EOVAP as the dependent variable, to investigate potential associations with prehospital airway management.

Results: A total of 131 episodes (58.7%) of EOVAP were registered in the study population (223 patients). Laryngeal tube and orotracheal intubation were used in patients with significantly lower Glasgow Coma Scale score on scene and a higher Face Abbreviated Injury Scale; advanced airway management significantly increased the total rescue time. The prehospital airway management technique adopted, prehospital type of sedation or use of muscle relaxants, type of transport, and rescue times were not associated with the occurrence of EOVAP.

Conclusions: Prehospital airway management does not have a significant impact on the occurrence of EOVAP in severe TBI patients. Similarly, it does not have a significant impact on mortality or long-term neurological outcome despite increasing duration of mechanical ventilation, intensive care unit, and hospital stay.

Keywords: emergency medical services; prehospital emergency care; risk factors; traumatic brain injury; ventilator-associated pneumonia.

MeSH terms

Adult
Airway Management / methods
Airway Management / standards*
Airway Management / statistics & numerical data
Brain Injuries, Traumatic / complications*
Brain Injuries, Traumatic / therapy
Chi-Square Distribution
Female
Glasgow Coma Scale
Humans
Italy
Male
Middle Aged
Pneumonia, Ventilator-Associated / diagnosis
Pneumonia, Ventilator-Associated / etiology*
Pneumonia, Ventilator-Associated / physiopathology
Respiration, Artificial / adverse effects
Respiration, Artificial / methods
Retrospective Studies
Time Factors*