Influencing factors for postoperative ventilator-associated pneumonia in patients with severe traumatic brain injuries
Objective To analyze the incidence of postoperative ventilator-associated pneumonia(VAP)in patients with severe traumatic brain injuries(TBI).Methods A retrospective analysis was conducted on the clinical data of 240 patients with severe TBIs and treated with craniotomy in our hospital from Jan.2018 to Jan.2022.There were 135 males and 105 females aged 42-68(mean 53.2)years,with 156 road traffic injuries,64 me-chanical injuries,and 20 others.According to whether VAP occurred after surgery,patients were divided into infected group(63 cases)and uninfected group(177 cases).Univariate analysis was conducted on clinical data of two groups,and Logistic stepwise regression was further adopted to analyze the risk factors.ROC curves were drawn to analyze the predictive value of serum procalcitonin(PCT),C-reactive protein(CRP),soluble triggering receptor ex-pressed on myeloid cell-1(sTREM-1),and proadrenomedullin(pro-ADM)for postoperative incidence of VAP in se-vere TBI patients.Results There was no statistically significant difference between the infected and uninfected groups in gender,age,BMI(all P＞0.05),but much higher proportions of patients with secondary surgery and≥14 d mechanical ventilation,and much higher levels of serum PCT,CRP,sTREM-1,and pro-ADM levels on the post-operative 3rd day were figured out in the infected group(all P＜0.05).Further Logistic regression analysis showed the risk factors for postoperative VAP in severe TBI patients:secondary surgery(OR=2.136,95％CI=1.322-3.451,P=0.002),mechanical ventilation time≥14 d(OR=2.281,95％CI=1.176-4.424,P=0.015),PCT≥0.58 ng/mL(OR=2.512,95％CI=1.348-4.681,P=0.004),CRP≥ 66.04 mg/mL(OR=2.446,95％CI=1.225-4.884,P=0.011),sTREM-1≥ 63.65 pg/mL(OR=2.279,95％CI=1.372-3.786,P=0.001),pro-ADM ≥ 45.19 pg/mL(OR=2.252,95％CI=1.319-3.845,P=0.003).ROC curve analysis showed that to predict postoperative VAP in severe TBI patients,the optimal cutoff values were 0.58 ng/mL by PCT,66.04 mg/mL by CRP,63.65 pg/mL by sTREM-1,and 45.19 pg/mL by pro-ADM.Conclusion Secondary surgery,mechanical ventilation time≥14 d,PCT ≥ 0.58 ng/mL,CRP≥66.04 mg/mL,sTREM-1≥63.65 pg/mL,and pro-ADM≥ 45.19 pg/mL are risk factors for postoperative VAP in severe TBI patients.Monitoring of these risk factors and protective use of the optimal cutoff with active intervention may improve patient prognosis.
Severe traumatic brain injuriesVentilator-associated pneumoniaProcalcitoninC-reactive proteinSoluble triggering receptor expressed on myeloid cell-1Proadrenomedullin
NETL
NSTL
万方数据
