title: Effect of a fever control protocol-based strategy on ventilator-associated pneumonia in severely brain-injured patients.
abstract: BACKGROUND
  Fever is associated with a poor outcome in severely brain-injured patients, and its control is one of the therapies used in this condition. But, fever suppression may promote infection, and severely brain-injured patients are frequently exposed to infectious diseases, particularly ventilator-associated pneumonia (VAP). Therefore, we designed a study to explore the role of a fever control protocol in VAP development during neuro-intensive care.
  
  
  METHODS
  An observational study was performed on severely brain-injured patients hospitalized in a university ICU. The primary goal was to assess whether fever control was a risk factor for VAP in a prospective cohort in which a fever control protocol was applied and in a historical control group. Moreover, the density of VAP incidence was compared between the two groups. The statistical analysis was based on a competing risk model multivariate analysis.
  
  
  RESULTS
  The study included 189 brain-injured patients (intervention group, n = 98, and historical control group, n = 91). The use of a fever control protocol was an independent risk factor for VAP (hazard ratio 2.73, 95% confidence interval (1.38, 5.38; P = 0.005)). There was a significant increase in the incidence of VAP in patients treated with a fever control protocol (26.1 versus 12.5 VAP cases per 1000 days of mechanical ventilation). In cases in which a fever control protocol was applied for > 3 days, we observed a higher rate of VAP in comparison with the rate among patients treated for ≤ 3 days.
  
  
  CONCLUSIONS
  Fever control in brain-injured patients was a major risk factor for VAP occurrence, particularly when applied for > 3 days.
authors.affiliation: CHU de Rennes. Hôpital Pontchaillou. Pôle Anesthésie-SAMU-Urgences-Réanimations. 2, rue Henri Le Guilloux, 35033, Rennes, Cedex, France. yoann.launey@chu-rennes.fr.|Inserm UMR991, équipe 2: "Stress, Defense and Regeneration". 2, rue Henri Le Guilloux, 35000, Rennes, France. yoann.launey@chu-rennes.fr.|Université Rennes 1, 35033, Rennes, Cedex, France. yoann.launey@chu-rennes.fr.
authors.forename: Yoann
authors.initials: Y
authors.lastname: Launey
authors.affiliation: CHU de Rennes. Hôpital Pontchaillou. Pôle Anesthésie-SAMU-Urgences-Réanimations. 2, rue Henri Le Guilloux, 35033, Rennes, Cedex, France. nicolas.nesseler@chu-rennes.fr.|Inserm UMR991, équipe 2: "Stress, Defense and Regeneration". 2, rue Henri Le Guilloux, 35000, Rennes, France. nicolas.nesseler@chu-rennes.fr.|Université Rennes 1, 35033, Rennes, Cedex, France. nicolas.nesseler@chu-rennes.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Nesseler
authors.affiliation: CHU de Rennes. Hôpital Pontchaillou. Pôle Anesthésie-SAMU-Urgences-Réanimations. 2, rue Henri Le Guilloux, 35033, Rennes, Cedex, France. audrenlc@wanadoo.fr.|Université Rennes 1, 35033, Rennes, Cedex, France. audrenlc@wanadoo.fr.
authors.forename: Audren
authors.initials: A
authors.lastname: Le Cousin
authors.affiliation: Plateforme de Biométrie - Cellule de promotion à la recherche clinique, CHU Nantes, EA 4275 SPHERE "Biostatistics, Pharmacoepidemiology & Human Sciences Research", UFR de Pharmacie, Université de Nantes. 1, rue Gaston Veil, 44000, Nantes, France. fanny.feuillet@univ-nantes.fr.
authors.forename: Fanny
authors.initials: F
authors.lastname: Feuillet
authors.affiliation: Ecole Nationale Hautes Etudes de Santé Publique. 2, Avenue du Professeur Léon Bernard, 35033, Rennes, Cedex, France. ronan.garlantezec@ehesp.fr.
authors.forename: Ronan
authors.initials: R
authors.lastname: Garlantezec
authors.affiliation: CHU de Rennes. Hôpital Pontchaillou. Pôle Anesthésie-SAMU-Urgences-Réanimations. 2, rue Henri Le Guilloux, 35033, Rennes, Cedex, France. yannick.malledant@chu-rennes.fr.|Inserm UMR991, équipe 2: "Stress, Defense and Regeneration". 2, rue Henri Le Guilloux, 35000, Rennes, France. yannick.malledant@chu-rennes.fr.|Université Rennes 1, 35033, Rennes, Cedex, France. yannick.malledant@chu-rennes.fr.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Mallédant
authors.affiliation: CHU de Rennes. Hôpital Pontchaillou. Pôle Anesthésie-SAMU-Urgences-Réanimations. 2, rue Henri Le Guilloux, 35033, Rennes, Cedex, France. philippe.seguin@chu-rennes.fr.|Inserm UMR991, équipe 2: "Stress, Defense and Regeneration". 2, rue Henri Le Guilloux, 35000, Rennes, France. philippe.seguin@chu-rennes.fr.|Université Rennes 1, 35033, Rennes, Cedex, France. philippe.seguin@chu-rennes.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Seguin
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index