Ventilator-Associated Pneumonia Risk in Traumatic Brain Injury Patients

Author(s):
Raj Malhotra; Kiley Timmons; Brian Zeng; Helen Horng; Christopher Graham; Joanelle Bailey; Nina Glass

Background:

Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality among trauma patients admitted to the Intensive Care Unit (ICU). Past studies have identified TBI as a risk factor for developing VAP, given patients altered mental status before intubation with its risk of aspiration and possible need for prolonged intubation. In this study, we aimed to characterize risk factors for VAP in this high-risk subgroup of TBI patients, in an effort to identify methods to mitigate this risk.

Hypothesis:

We hypothesized that VAP would be associated with TBI severity and therefore screening for pneumonia with BAL on certain TBI patients to initiate earlier therapy would be warranted. We therefore sought to describe our baseline data before initiating a quality improvement project.

Methods:

We reviewed trauma patients from 01/2019 through 05/2022 admitted to the ICU. Patient demographics, injury characteristics, and VAP status were reviewed with a focus on head abbreviated injury severity scores (AIS) and intubation status. We compared VAP and non-VAP patients to identify possible risk factors for developing VAP among patients without TBI (Head AIS=0), with mild to moderate TBI (Head AIS=1-2), and with severe TBI (Head AIS≥3). 

Results:

Severe TBI was a risk factor for VAP (10% VAP in severe TBI vs. 4% in mild-moderate, p<0.001). When controlling for demographics and injury characteristics, logistic regression analysis still demonstrated head AIS to be a significant predictor of VAP (OR=1.196, 95% CI=1.074-1.332, p=0.001).

Conclusions:

This single center experience confirms that severe TBI is a significant risk factor for VAP. Further investigation is necessary into factors that may affect VAP risk such as early intubation, early tracheostomy, and early antibiotics. We aim to further assess quality improvement projects we are implementing to optimize care of this high-risk group of patients.