Chest
Original ResearchCritical Care MedicinePrognostic Role of Clinical and Laboratory Criteria To Identify Early Ventilator-Associated Pneumonia in Brain Injury*
Section snippets
Patient Selection
Sixty-seven brain-injured patients admitted to the ICU of the Servizio Anestesia B, Ospedale di Circolo e Fondazione Macchi, Insubria University, Varese, Italy were identified over a 1-year period. The study was approved by the Ethical Committee of the Hospital and performed in accordance with the precepts established by Helsinki Declaration. Inclusion criteria were as follows: (1) severe brain injury, defined as a Glasgow coma scale (GCS) score at hospital entry ≤ 8, due to isolated brain
Clinical Characteristics and Acute-Phase Inflammatory Markers at Entry
We screened a total of 101 patients. We excluded 2 patients due to age < 18 years, 3 patients due to extrahospital cardiac arrest or brain death, and 29 patients due to severe multiple trauma.
We included 67 patients with severe brain injury, but 9 patients were further excluded from the analysis due to positive culture finding of the endotracheal aspirate or BAL at entry. The remaining 58 brain-injured patients fulfilling the inclusion criteria were admitted into the study. The diagnosis of
Discussion
This is the first study investigating the role of PCT and the CPIS for early detection of patients with early VAP in the setting of brain injury. In severe brain-injured patients, the most frequent medical complication is respiratory dysfunction, with an increased mortality and worse neurologic outcome.18, 19, 20, 21, 22 In this study we investigated changes in CRP,23 SAA,24, 25 PCT, and leukocytes. Serum concentrations of PCT have been reported to be markedly increased in a variety of clinical
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2018, British Journal of AnaesthesiaNeuropulmonology
2017, Handbook of Clinical NeurologyCitation Excerpt :Bilateral dependent consolidation as seen on admission CT is independently associated with the development of VAP following brain injury, and may be helpful in the identification of those patients more likely to experience VAP (Plurad et al., 2013). Jovanovic et al. (2015) found that the development of early VAP following severe brain injury was related to the extent of brain and other organ injury, while late VAP development was related to the extent of brain injury and age; the level of serum procalcitonin has been proposed as a predictive marker for the development of early VAP, and the clinical pulmonary infection score may be helpful in detecting early VAP (Pelosi et al., 2008). Although chest physiotherapy is commonly employed in the course of therapy following brain injury, compelling evidence is lacking for its utility in preventing or treating VAP, or in reducing the use of mechanical ventilation and ICU stay (Patman et al., 2009; Hellweg, 2012).
Anesthesia for Colorectal Surgery
2015, Anesthesiology ClinicsCitation Excerpt :Of interest, patients developing complications within 30 days from surgery have a 69% lower chance of surviving at 8 years.10 General7,11 and organ-specific12–16 preoperative scoring systems and assessment of functional capacity17,18 can help to predict and stratify preoperative risk. The preoperative evaluation is also an opportunity to improve long-term health besides surgery, such as counseling patients who may benefit from long-term β-blockers, stopping smoking, or tightening glycemic control.
This study was performed at the Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
This study was not supported by any financial support, and all the authors declare disclosure of any personal or financial support or financial interest in the subject matter or any actual or potential conflict of interest.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).