Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Feb;32(1):272-285.
doi: 10.1007/s12028-019-00773-w.

Incidence, Risk Factors, and Outcomes of Ventilator-Associated Pneumonia in Traumatic Brain Injury: A Meta-analysis

Yating Li  1   2 , Chenxia Liu  1   2 , Wei Xiao  3 , Tiantian Song  1   2 , Shuhui Wang  4
Affiliations
Review

Incidence, Risk Factors, and Outcomes of Ventilator-Associated Pneumonia in Traumatic Brain Injury: A Meta-analysis

Yating Li et al. Neurocrit Care. 2020 Feb.

Abstract

Ventilator-associated pneumonia (VAP) is one of the most severe complications in patients with traumatic brain injury (TBI) and is considered a risk factor for poor outcomes. However, the incidence of VAP among patients with TBI reported in studies varies widely. What is more, the risk factors and outcomes of VAP are controversial. This study estimates the incidence, risk factors, and outcomes of VAP in patients with TBI and provides evidence for prevention and treatment. PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched from the earliest records to May 2018. Data involving the incidence, risk factors, and outcomes were extracted for meta-analysis. The results showed that the incidence of VAP was 36% (95% confidence interval (CI) 31-41%); risk factors analyses showed that smoking [odds ratio (OR) 2.13; 95% CI 1.16-3.92], tracheostomy (OR 9.55; 95% CI 3.24-28.17), blood transfusion on admission (OR 2.54; 95% CI 1.24-5.18), barbiturate infusion (OR 3.52; 95% CI 1.68-7.40), injury severity score (OR 4.65; 95% CI 1.96-7.34), and head abbreviated injury scale (OR 2.99; 95% CI 1.66-5.37) were related to the occurrence of VAP. When patients developed VAP, mechanical ventilation time (OR 5.45; 95% CI 3.78-7.12), ICU length of stay (OR 6.85; 95% CI 4.90-8.79), and hospital length of stay (OR 10.92; 95% CI 9.12-12.72) were significantly increased. However, VAP was not associated with an increased risk of mortality (OR 1.28; 95% CI 0.74-2.21). VAP is common in patients with TBI. It is affected by a series of factors and has a poor prognosis.

Keywords: Incidence; Outcome; Risk factors; Traumatic brain injury; Ventilator-associated pneumonia.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of the study selection process
Fig. 2
Fig. 2
a Incidence of VAP in patients with TBI (CI confidence interval, ID identification). b Incidence of VAP by subgroup analysis of study design (prospective and retrospective) (CI confidence interval, ID identification). c Incidence of VAP by subgroup analysis of the region (CI confidence interval, ID identification). d Incidence of VAP by subgroup analysis of the definition of VAP (CI confidence interval, ID identification). e Incidence of VAP by subgroup analysis of the severity of TBI (CI confidence interval, ID identification, TBI traumatic brain injury). f Incidence of EOVAP in patients with TBI (CI confidence interval, ID identification). g Incidence of LOVAP in patients with TBI (CI confidence interval, ID identification)
Fig. 2
Fig. 2
a Incidence of VAP in patients with TBI (CI confidence interval, ID identification). b Incidence of VAP by subgroup analysis of study design (prospective and retrospective) (CI confidence interval, ID identification). c Incidence of VAP by subgroup analysis of the region (CI confidence interval, ID identification). d Incidence of VAP by subgroup analysis of the definition of VAP (CI confidence interval, ID identification). e Incidence of VAP by subgroup analysis of the severity of TBI (CI confidence interval, ID identification, TBI traumatic brain injury). f Incidence of EOVAP in patients with TBI (CI confidence interval, ID identification). g Incidence of LOVAP in patients with TBI (CI confidence interval, ID identification)
Fig. 2
Fig. 2
a Incidence of VAP in patients with TBI (CI confidence interval, ID identification). b Incidence of VAP by subgroup analysis of study design (prospective and retrospective) (CI confidence interval, ID identification). c Incidence of VAP by subgroup analysis of the region (CI confidence interval, ID identification). d Incidence of VAP by subgroup analysis of the definition of VAP (CI confidence interval, ID identification). e Incidence of VAP by subgroup analysis of the severity of TBI (CI confidence interval, ID identification, TBI traumatic brain injury). f Incidence of EOVAP in patients with TBI (CI confidence interval, ID identification). g Incidence of LOVAP in patients with TBI (CI confidence interval, ID identification)
Fig. 2
Fig. 2
a Incidence of VAP in patients with TBI (CI confidence interval, ID identification). b Incidence of VAP by subgroup analysis of study design (prospective and retrospective) (CI confidence interval, ID identification). c Incidence of VAP by subgroup analysis of the region (CI confidence interval, ID identification). d Incidence of VAP by subgroup analysis of the definition of VAP (CI confidence interval, ID identification). e Incidence of VAP by subgroup analysis of the severity of TBI (CI confidence interval, ID identification, TBI traumatic brain injury). f Incidence of EOVAP in patients with TBI (CI confidence interval, ID identification). g Incidence of LOVAP in patients with TBI (CI confidence interval, ID identification)
Fig. 3
Fig. 3
Outcomes of VAP among patients with TBI. a Mortality; b mechanical ventilation time; c ICU length of stay; d hospital length of stay (CI confidence interval, IV inverse variance, M–H Mantel–Haenszel, SD standard deviation, VAP ventilator-associated pneumonia)
See this image and copyright information in PMC

References

    1. Cristofori I, Levin HS. Traumatic brain injury and cognition. Handb Clin Neurol. 2015;128:579–611. doi: 10.1016/B978-0-444-63521-1.00037-6. - DOI - PubMed
    1. Alali AS, Burton K, Fowler RA, et al. Economic evaluations in the diagnosis and management of traumatic brain injury: a systematic review and analysis of quality. Value Health. 2015;18(5):721–734. doi: 10.1016/j.jval.2015.04.012. - DOI - PubMed
    1. Griffin GD. The injured brain: TBI, mTBI, the immune system, and infection: connecting the dots. Mil Med. 2011;176(4):364–368. doi: 10.7205/MILMED-D-10-00021. - DOI - PubMed
    1. Ngubane T. Mechanical ventilation and the injured brain. South Afr J Anaesth Analg. 2011;17(1):76–80.
    1. Pileggi C, Bianco A, Flotta D, Nobile CGA, Pavia M. Prevention of ventilator-associated pneumonia, mortality and all intensive care unit acquired infections by topically applied antimicrobial or antiseptic agents: a meta-analysis of randomized controlled trials in intensive care units. Crit Care. 2011;15(3):R155. doi: 10.1186/cc10285. - DOI - PMC - PubMed

MeSH terms