Effect of a fever control protocol-based strategy on ventilator-associated pneumonia in severely brain-injured patients. - MULTIGNER-QUENEL - Evaluation des expositions et recherche épidémiologique sur l'environnement, la reproduction et le développement (3ERD) Accéder directement au contenu
Article Dans Une Revue Critical Care Année : 2014

Effect of a fever control protocol-based strategy on ventilator-associated pneumonia in severely brain-injured patients.

Résumé

IntroductionFever 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.MethodsAn 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.ResultsThe 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.ConclusionFever control in brain-injured patients was a major risk factor for VAP occurrence, particularly when applied for >3 days.

Dates et versions

hal-01118640 , version 1 (19-02-2015)

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Yoann Launey, Nicolas Nesseler, Audren Le Cousin, Fanny Feuillet, Ronan Garlantezec, et al.. Effect of a fever control protocol-based strategy on ventilator-associated pneumonia in severely brain-injured patients.. Critical Care, 2014, 18 (6), pp.689. ⟨10.1186/s13054-014-0689-4⟩. ⟨hal-01118640⟩
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