Pulmonary Infection in Traumatic Brain Injury Patients Undergoing Tracheostomy: Predicators and Nursing Care

Background: Pulmonary infection is common yet serious complication in patients with severe traumatic brain injury (STBI). We aimed to evaluate the predicators of pulmonary infection in STBI patients undergoing tracheostomy, to provide evidence for the clinical nursing care of STBI patients.

Methods: This study was a retrospective cohort design. STBI patients undergoing tracheostomy treatment from January 1, 2019 to August 31, 2021 in our hospital were included. The characteristics of pulmonary infection and no pulmonary infection patients were analyzed.

Results: A total 216 STBI patients undergoing tracheostomy were included, the incidence of pulmonary infection was 26.85%. Diabetes (r = 0.782), hypoproteinemia (r = 0.804), duration of coma(r = 0.672), duration of mechanical ventilation(r = 0.724) and length of hospital stay (r = 0.655), length of hospital stay post tracheostomy (r = 0.554), mortality (r = 0.598) were all correlated with pulmonary infection (all p < 0.05). Klebsiella pneumoniae (33.87%) and Staphylococcus aureus (29.03%) were the most commonly seen pathogens in the pulmonary infection of TBI patients. Logistic regression analyses indicated that diabetes (OR 2.232, 95% CI 1.215-3.904), hypoproteinemia with plasma total protein < 60 g/L (OR 1.922, 95% CI 1.083-3.031), duration of coma ≥ 22 h (OR 2.864, 95% CI 1.344-5.012), duration of mechanical ventilation ≥ 5 days (OR 3.602, 95% CI 1.297-5.626), length of hospital stay ≥ 21 days (OR 2.048, 95% CI 1.022-3.859) were the risk factors of pulmonary infection in TBI patients undergoing tracheostomy (all p < 0.05).

Conclusions: Further investigations on the early preventions and treatments targeted on those risk factors are needed to reduce the pulmonary infection in clinical practice.