Effect of a Fever Control Protocol-based Strategy on Ventilator-associated Pneumonia in Severely Brain-injured Patients

Overview

Journal Crit Care

Specialty Critical Care

Date 2014 Dec 16

PMID 25498970

Citations 10

Authors

Yoann Launey

Nicolas Nesseler

Audren Le Cousin

Fanny Feuillet

Ronan Garlantezec

Yannick Malledant

Philippe Seguin

Affiliations

Soon will be listed here.

Abstract

Introduction: Fever 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.

Methods: An 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.

Results: The 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.

Conclusions: Fever control in brain-injured patients was a major risk factor for VAP occurrence, particularly when applied for > 3 days.

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