Impact of ventilator-associated pneumonia in patients with severe head injury.
BACKGROUND
The impact of ventilator-associated pneumonia (VAP) on outcome seems to vary depending on the critically ill patients we analyze. Our objective, therefore, has been to evaluate the influence of VAP on the mortality and morbidity in patients with severe head injury (Glasgow Coma Scale score </= 8).


METHODS
A prospective, matched, case-control study was conducted in our intensive care unit (ICU) for a 3-year period (1998-2000). Seventy-two patients with severe head injury (HI) who developed VAP were matched with 72 patients with severe HI without VAP. The matching criteria were as follows: age (+/- 5 years); category of HI based on computed tomographic scanning; Acute Physiology and Chronic Health Evaluation II (+/- 4 points) score; Injury Severity Score (+/- 4 points); and duration of mechanical ventilation. VAP was diagnosed on the basis of quantitative microbiologic criteria.


RESULTS
Mortality did not differ significantly between cases and matched control subjects (15 [20.8%] vs. 11 [15.3%], p = 0.54). However, patients with VAP had a significantly longer duration of mechanical ventilation (median, 14 vs. 10 days; p = 0.015) and ICU stay (median, 21 vs. 15.5 days; p = 0.008). The occurrence of multiple organ failure was also significantly more frequent among the case group (33.3% vs. 12.5%, p = 0.004) during the overall ICU stay.


CONCLUSIONS
VAP does not seem to be associated with a significantly increased risk of death in patients with severe HI, but it may be associated with greater morbidity during the ICU stay.
Rincón-Ferrari
M Dolores
MD
Critical Care and Emergency Department, University Hospital Virgen del Rocío, Seville, Spain. marilorincon@hotmail.com
Flores-Cordero
Juan M
JM
Leal-Noval
S Ramón
SR
Murillo-Cabezas
Francisco
F
Cayuelas
Aurelio
A
Muñoz-Sánchez
M Angeles
MA
Sánchez-Olmedo
J Ignacio
JI
D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D009017:Morbidity; D011015:Pneumonia, Aspiration / Q000150:complications* / Q000209:etiology / Q000382:microbiology; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012306:Risk; D013030:Spain / Q000453:epidemiology