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The following is a summary of “Risk factors and outcomes of ventilator-associated pneumonia in patients with traumatic brain injury: A systematic review and meta-analysis,” published in the February 2025 issue of Journal of Critical Care by Prieto-Alvarado et al.
Ventilator-associated pneumonia (VAP) frequently emerged in individuals with traumatic brain injury (TBI), increasing morbidity and affecting outcomes, while risk factors and outcomes remained uncertain.
Researchers conducted a retrospective study to analyze the risk factors and clinical outcomes in individuals with VAP and TBI.
They performed systematic literature searches in PubMed, Cochrane Database, Scopus, Medline Ovid, and Science Direct, covering studies from inception to January 2024. Study quality was evaluated by the Newcastle-Ottawa Scale. The meta-analysis used a random-effects model for heterogeneity (I2 > 50%) and a fixed-effects model for I2 < 50% and subgroup analysis identified VAP risk factors, while publication bias was estimated using the funnel plot, Begg’s, and Egger’s tests. Statistical significance was set at P < 0.05. The certainty of evidence was assessed with GRADE (Grading of Recommendations Assessment, Development, and Evaluation).
The results showed that 12 studies with 2,883 individuals were included. Male gender [odds ratios (OR) 1.58 (95% (CI) 1.23, 2.02) P < 0.05 I2 0%] and head abbreviated injury scale (H-AIS) [≥ 3 OR 2.79 (95% CI 1.58, 4.93) P < 0.05 I2 0%] increased the risk of VAP. Subgroup analysis revealed blood transfusion on admission [OR 1.97 (95% CI 1.16–3.35) P ≤ 0.05 I2 5%] and barbiturate infusion [OR 3.55 (95% CI 2.01–6.30) P ≤ 0.05 I2 0%] as additional risk factors. Prophylactic antibiotic use [OR 0.67 (95% CI 0.51–0.88) P ≤ 0.05 I2 0%] and younger age [Mean Difference (MD) -3.29 (95% CI -5.18, −1.40) P ≤ 0.05 I2 41%] were identified as protective factors. In patients with VAP, Intensive Care Unit (ICU) stay [MD 7.02 (95% CI 6.05–7.99) P ≤ 0.05 I2 37%], duration of mechanical ventilation (MV) [MD 5.79 (95% CI 4.40, 7.18) P ≤ 0.05 I2 79%], and hospital stay [MD 11.88 (95% CI 8.71–15.05) P ≤ 0.05 I2 0%] were significantly prolonged.
Investigators concluded that male gender, H-AIS ≥ 3, blood transfusion on admission, and barbiturate infusion were risk factors for VAP and that significantly increased ICU stay, duration of mechanical ventilation, and hospital stay.
Source: sciencedirect.com/science/article/pii/S088394412400409X?via%3Dihub
