Abstract:
INTRODUCTION: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.
journal_name
Crit Carejournal_title
Critical care (London, England)authors
Launey Y,Nesseler N,Le Cousin A,Feuillet F,Garlantezec R,Mallédant Y,Seguin Pdoi
10.1186/s13054-014-0689-4subject
Has Abstractpub_date
2014-12-15 00:00:00pages
689issue
6eissn
1364-8535issn
1466-609Xpii
s13054-014-0689-4journal_volume
18pub_type
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