Influence on outcome of ventilator-associated pneumonia in multiple trauma patients with head trauma treated with selected digestive decontamination.
OBJECTIVE
Ventilator-associated pneumonia is said to be associated with an increased mortality or a prolonged intensive care unit stay. In multiple trauma, the use of selective digestive decontamination has been reported to decrease morbidity and mortality associated with pneumonia. We performed a study to evaluate the attributable morbidity and mortality of ventilator-associated pneumonia in multiple trauma patients with head trauma treated with selective digestive decontamination.


METHODS
Prospective, matched-paired, case-control study.


METHODS
Intensive care unit at a tertiary university hospital.


METHODS
During a 6-yr period, 324 consecutive multiple trauma patients with head trauma requiring mechanical ventilation for >48 hrs were prospectively followed for the development of VAP. Case-control matching criteria were as follows: 1) age difference within 5 yrs, 2) Glasgow coma scale within five categories, 3) injury severity score within 5 points, 4) APACHE II score within 5 points, 5) ventilation of control patients for at least as long as the cases. The selective digestive decontamination regimen was used in all patients (cases and controls): polymixin E, gentamicin, and amphotericin B. Systemic cefazolin (1 g three times a day) was given for the first 3 days of intensive care unit stay.


RESULTS
Analysis was performed on 58 pairs that were matched with 100% of success The most common isolates recovered were Staphylococcus aureus (39%) and Haemophilus influenzae (22%). High-risk pathogens were rarely isolated: Pseudomonas aeruginosa (5.1%), Acinetobacter species (8.6%), and methicillin-resistant S. aureus (6.7%). The duration of mechanical ventilation and intensive care unit stay were increased in case patients (11.6 +/- 1.7 and 22.7 +/- 2.9 days, respectively) compared with control patients (9.4 +/- 1.3 and 16.8 +/- 2.9 days, respectively; p <.0006). Mortality was similar in both case (17%) and control (24%) patients.


CONCLUSIONS
Ventilator-associated pneumonia did not seem to increase mortality of multiple trauma patients with head trauma who received selective digestive decontamination. Whether or not this conclusion applied to trauma patients not receiving selective digestive decontamination should be evaluated in further studies.
Leone
Marc
M
Intensive Care Unit and Trauma Center, Nord Hospital, Marseilles University Hospital System, Marseilles School of Medicine, Marseilles, France. marc-leone@ap-hm.fr
Bourgoin
Aurélie
A
Giuly
Elsa
E
Antonini
François
F
Dubuc
Myriam
M
Viviand
Xavier
X
Albanèse
Jacques
J
Martin
Claude
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018893:Bronchoalveolar Lavage; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000382:microbiology; D016022:Case-Control Studies; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D003428:Cross Infection / Q000150:complications*; D003666:Decontamination; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D011023:Pneumonia, Staphylococcal / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D012122:Ventilators, Mechanical / Q000009:adverse effects*