title: Ventilator-Associated Pneumonia in Pediatric Traumatic Brain Injury.
abstract: Ventilator-associated pneumonia (VAP) is a common occurrence among intubated pediatric traumatic brain injury (TBI) patients. However, little is known about the epidemiology, risk factors, and microbiology of VAP in pediatric TBI. We reviewed a cohort of 119 pediatric moderate-to-severe TBI patients and identified 42 with VAP by positive protected bronchial brush specimens. Location of intubation, severity of injury, and antibiotic administration within 2 days after injury were not associated with VAP. Most treatments for elevated intracranial pressure were associated with increased risk of VAP; however, in a multi-variable analysis barbiturate coma (hazard ratio [HR], 3.2; 95% confidence interval [CI] 1.4-7.3), neuromuscular blockade (NMBA; HR, 3.4; 95% CI 1.6-7.3), and use of a cooling blanket for euthermia (HR 2.4; 95% CI 1.1-5.5) remained independently associated with VAP. Most VAP (55%) occurred prior to hospital Day 4 and only 7% developed VAP after Day 7. Methicillin-sensitive Staphylococcus aureus (34%), Haemophilus influenzae (22%), and Streptococcus pneumoniae (15%) were the most common organisms, comprising 71% of isolated pathogens (36% of infections were polymicrobial). Patients with VAP had significantly longer intensive care unit and hospital stays, as well as increased risk of chronic care needs after discharge, but not mortality. VAP is a common occurrence in pediatric TBI patients, and early empiric therapy for patients requiring barbiturate infusion, NMBA, or use of a cooling blanket could mitigate morbidity.
authors.affiliation: 1 Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Hamele
authors.affiliation: 1 Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah.
authors.forename: Chris
authors.initials: C
authors.lastname: Stockmann
authors.affiliation: 1 Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah.
authors.forename: Meghan
authors.initials: M
authors.lastname: Cirulis
authors.affiliation: 2 Department of Neurosurgery, University of Utah School of Medicine , Salt Lake City, Utah.
authors.forename: Jay
authors.initials: J
authors.lastname: Riva-Cambrin
authors.affiliation: 3 Division of Pediatric Surgery, University of Utah School of Medicine , Salt Lake City, Utah.
authors.forename: Ryan
authors.initials: R
authors.lastname: Metzger
authors.affiliation: 4 Pediatric Critical Care, University of Colorado School of Medicine , Aurora, Colorado.
authors.forename: Tellen D
authors.initials: TD
authors.lastname: Bennett
authors.affiliation: 1 Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
mesh_terms: D000293:Adolescent; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000639:trends*; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000209:etiology*; D012189:Retrospective Studies
keywords: pediatric; pneumonia; traumatic brain injury