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Ventilator-Associated Pneumonia in Pediatric Traumatic Brain Injury

Mitchell Hamele1, Chris Stockmann1, Meghan Cirulis1

  • 11 Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah.

Journal of Neurotrauma
|July 24, 2015
PubMed

Insights

Ventilator-associated pneumonia (VAP) is common in pediatric traumatic brain injury (TBI) patients. Treatments like barbiturate coma, neuromuscular blockade, and cooling blankets increase VAP risk, leading to longer hospital stays.

Area of Science:

  • Pediatric critical care medicine
  • Infectious disease epidemiology
  • Neurotrauma research

Background:

  • Ventilator-associated pneumonia (VAP) is a significant complication in intubated pediatric patients with moderate-to-severe traumatic brain injury (TBI).
  • Limited data exists on the specific epidemiology, risk factors, and causative microorganisms of VAP in this vulnerable population.
  • Understanding these factors is crucial for developing targeted prevention and treatment strategies.

Purpose of the Study:

  • To investigate the incidence, risk factors, microbiology, and clinical outcomes of VAP in pediatric patients with moderate-to-severe TBI.
  • To identify specific treatments or patient characteristics associated with an increased risk of developing VAP.
  • To inform clinical practice regarding the early management of VAP in this cohort.

Main Methods:

  • Retrospective cohort review of 119 pediatric patients with moderate-to-severe TBI.
  • Identification of VAP cases through positive protected bronchial brush specimens.
  • Multivariable analysis to determine independent risk factors for VAP development.

Main Results:

  • VAP was identified in 42 patients (35%).
  • Barbiturate coma (HR 3.2), neuromuscular blockade (NMBA; HR 3.4), and cooling blankets (HR 2.4) were independently associated with increased VAP risk.
  • Common pathogens included Methicillin-sensitive Staphylococcus aureus (34%), Haemophilus influenzae (22%), and Streptococcus pneumoniae (15%). Most VAP occurred early (before Day 4).
  • VAP was associated with longer ICU and hospital stays and increased need for chronic care, but not mortality.

Conclusions:

  • VAP is a frequent complication in pediatric TBI patients, often occurring early in the hospital course.
  • Specific intensive care interventions, including barbiturate coma, NMBA, and cooling blankets, are significant risk factors for VAP.
  • Early empiric antibiotic therapy for high-risk patients may help reduce morbidity associated with VAP in pediatric TBI.

Keywords:
pediatricpneumoniatraumatic brain injury

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