isk Factors and Outcomes of Lower Respiratory Infections in Patients with Traumatic Brain Injury
Abstract
Background: Respiratory infections are a widespread and rapidly spreading disease that plays an important role in the mortality of children and adults. This study aimed to determine the prevalence, contributing factors, and outcomes of LRTI in patients with TBI.
Methods: In this study, 140 patients who were admitted to the ICU with a diagnosis of TBI were included in the study. Patients who had respiratory infections, including hospital-acquired pneumoniae (HAP), ventilator-associated tracheobronchitis (VAT), and ventilator-associated pneumoniae (VAP), were included in the group of patients with LRTI. The diagnosis of LRTI is based on laboratory indicators and the methodology of previous articles. The tool used in this study was a checklist including the data registry. This checklist was completed by the researchers and by visiting the department daily. In all stages of this study, the instructions issued by the Ethics Committee were followed. Also, data analysis was performed with the help of SPSS 18 software.
Results: In this study, out of 140 patients admitted to the ICU, 47 (33.6%) patients had LRTI and 93 (66.4%) patients had no symptoms of LRTI. The result showed that most patients were male (73.6%), had no history of pregnancy (99.3%), had no bedsores (81.4%), were admitted from the Emergency Department (52.9%), and had blunt trauma (79.3%). Also, the M(SD) age of the patients was 45.05 (11.1), the M(SD) length of hospital stay was 6.25 (1.8), and the mean (SD) consciousness score was 7.82 (2.22). Regarding the relationship between the status of the variables studied and the rate of LRTI, it was shown that there was a significant relationship between ICU LOS and age with LRTI status. So that the M(SD) of ICU LOS in patients with LRTI was 5.38 (2.21) and in patients without LRTI was 3.55 (1.45), (95% CI: 2.11 (1.98-2.23)). Also, the M(Sd) age of patients in the LRTI group was 46.76 (13.47), and in the No LRTI group was 44.19 (9.65) (95% CI: 1.87 (1.51-2.22)). Also, the mortality rate in patients with LRTI was 36.2%, which was higher than the mortality rate of non-LRTI patients with a mortality rate of 8.6%.
Conclusion: Given the high incidence of LRTI, preventive measures are recommended in this regard. Also, patient age and ICU LOS were identified as two important variables in the incidence of LRTI, which requires these patients to be prioritized for preventive care in order to reduce the incidence of LRTI.
[2] Hatefi M, Tarjoman A, Moradi S, Borji M. The effect of eye movement desensitization and reprocessing on depression and anxiety in patients with spinal cord injuries. Trauma Mon. 2019; 24(5): 1-6.
[3] Karimian M, Okhli A, Noormohammadi-Dehbalaee A, Gholami A, Abdi A, Salimi E, et al. Prevalence of vascular trauma and related factors in Iran: A systematic review. Int J Med Toxicol Forensic Med. 2021; 11(2): 31441.
[4] Sharma R, Shultz SR, Robinson MJ, Belli A, Hibbs ML, O'Brien TJ, et al. Infections after a traumatic brain injury: The complex interplay between the immune and neurological systems. Brain Behav Immun. 2019; 79: 63-74.
[5] Gandasasmita N, Li J, Loane DJ, Semple BD. Experimental models of hospital-acquired infections after traumatic brain injury: Challenges and opportunities. J Neurotrauma. 2024; 41(7-8): 752-70.
[6] Li R, Li J, Zhou X. Lung microbiome: New insights into the pathogenesis of respiratory diseases. Signal Transduct Target Ther. 2024; 9(1): 19.
[7] Dumas A, Bernard L, Poquet Y, Lugo‐Villarino G, Neyrolles O. The role of the lung microbiota and the gut–lung axis in respiratory infectious diseases. Cell Microbiol. 2018; 20(12): e12966.
[8] Liang SY. Sepsis and other infectious disease emergencies in the elderly. Emerg Med Clin North Am. 2016; 34(3): 501-22.
[9] Nazari Z, Tabarraei E, Akbarmehr J. Molecular epidemiology of adenoviruses among respiratory infected patients. Med Lab J. 2014; 8(1): 1-6.
[10] Sadeghifard N, Ghafourian S, Mohamadi J, Nazari A, Shahmari M, Pakzad R, et al. Evaluation of the patients’ conditions with respiratory tract infections and interventions to prevent taking antibiotics in these patients. J Ilam Univ Med Sci. 2023; 31(1): 42-51.
[11] Gogheri T, Samavi SA, Najarpourian S. Structural relationships model of type D personality and depression with the mediation of cognitive distortions and family functioning in the citizens of Bandar Abbas. Qom Univ Med Sci J. 2021; 15(6): 384-93.
[12] Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C. Estimates of worldwide distribution of child deaths from acute respiratory infections. Lancet Infect Dis. 2002; 2(1): 25-32.
[13] Powell K. Fever without a focus. Nelson Textbook of Pediatrics. 2004; 841-6.
[14] Javadi-Nia S, Noorbakhsh S, Izadi A, Shokrollahi MR, Asgarian R, Tabatabaei A. Vitamin A, D and zinc serum levels in children with and without acute respiratory tract infection in two university hospitals. Teheran Univ Med J. 2014; 71(12): 794-9.
[15] Zhao X, Liu Y, Zhang J, Fu S, Song C, Bai Y, et al. Acute lower respiratory tract infection increased the risk of cardiovascular events and all-cause mortality in elderly patients with stable coronary artery disease. Front Cardiovasc Med. 2021; 8.
[16] Violi F, Cangemi R, Calvieri C. Pneumonia, thrombosis and vascular disease. J Thromb Haemost. 2014; 12(9): 1391-400.
[17] Rajas O, Ortega-Gómez M, Galván Román JM, Curbelo J, Fernández Jiménez G, Vega Piris L, et al. The incidence of cardiovascular events after hospitalization due to CAP and their association with different inflammatory markers. BMC Pulm Med. 2014; 14: 197.
[18] Feldman C, Anderson R. Prevalence, pathogenesis, therapy, and prevention of cardiovascular events in patients with community-acquired pneumonia. Pneumonia (Nathan). 2016; 8: 11.
[19] Zhang J, Lim YH, So R, Mortensen LH, Napolitano GM, Cole-Hunter T, et al. Long-term exposure to air pollution and risk of acute lower respiratory infections in the Danish nurse cohort. Annals of the American Thoracic Society. 2024; 21(8):1129-38.
[20] Ghaffarpasand F, Saki MR, Dadashpour N, Ghahramani Z, Paydar S. Early tracheostomy in trauma patients with acute respiratory distress syndrome due to novel Coronavirus Disease 2019 (COVID-19). Bull Emerg Trauma. 2020; 8(3): 133-4.
[21] Hatefi M, Dastjerdi MM, Ghiasi B, Rahmani A. Association of serum uric acid level with the severity of brain injury and patient’s outcome in severe traumatic brain injury. J Clin Diagn Res. 2016; 10(12): OC20.
[22] Sadeghi S, Hatefi M, Rahmatian A, Mohammadi HR. Evaluate various factors related to mortality in patients affected by hypertensive cerebellar hemorrhage. Gomal J Med Sci. 2023; 21(4).
[23] Auerbach DI, Staiger DO, Muench U, Buerhaus PI. The nursing workforce in an era of health care reform. N Engl J Med. 2013; 368(16): 1470-2.
[24] Control CfD. Prevention. Pneumonia (ventilator-associated [VAP] and non-ventilator-associated pneumonia [PNEU]) event. Device-associated Module PNEU/VAP. 2015.
[25] Becerra-Hervás J, Guitart C, Covas A, Bobillo-Pérez S, Rodríguez-Fanjul J, Carrasco-Jordan JL, et al. The Clinical Pulmonary Infection Score combined with procalcitonin and lung ultrasound (CPIS-PLUS), a good tool for ventilator-associated pneumonia early diagnosis in pediatrics. Children. 2024; 11(5): 592.
[26] Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991; 143(5 Pt 1): 1121-9.
[27] Al Fauzi A, Apriawan T, Ranuh IAR, Christi AY, Bajamal AH, Turchan A, et al. Traumatic brain injury in pregnancy: A systematic review of epidemiology, management, and outcome. J Clin Neurosci. 2023; 107: 106-17.
[28] Vaajala M, Kuitunen I, Nyrhi L, Ponkilainen V, Kekki M, Luoto T, et al. Pregnancy and delivery after traumatic brain injury: a nationwide population-based cohort study in Finland. J Matern Fetal Neonatal Med. 2022; 35(25): 9709-16.
[29] Osis SL, Diccini S. Incidence and risk factors associated with pressure injury in patients with traumatic brain injury. Int J Nurs Pract. 2020; 26(3): e12821.
[30] Yoon JE, Cho O-H. Risk factors associated with pressure ulcers in patients with traumatic brain injury admitted to the intensive care unit. Clin Nurs Res. 2022; 31(4): 648-55.
[31] Caceres E, Olivella JC, Yanez M, Viñan E, Estupiñan L, Boada N, et al. Risk factors and outcomes of lower respiratory tract infections after traumatic brain injury: a retrospective observational study. Front Med (Lausanne). 2023; 10.
[32] Black KL, Hanks RA, Wood DL, Zafonte RD, Cullen N, Cifu DX, et al. Blunt versus penetrating violent traumatic brain injury: Frequency and factors associated with secondary conditions and complications. J Head Trauma Rehabil. 2002; 17(6): 489-96.
[33] Hui X, Haider AH, Hashmi ZG, Rushing AP, Dhiman N, Scott VK, et al. Increased risk of pneumonia among ventilated patients with traumatic brain injury: every day counts! J Surg Res. 2013; 184(1): 438-43.
[34] Hansen TS, Larsen K, Engberg AW. The association of functional oral intake and pneumonia in patients with severe traumatic brain injury. Arch Phys Med Rehabil. 2008; 89(11): 2114-20.
Files | ||
Issue | Article in Press |
|
Section | Research Article(s) | |
Keywords | ||
Traumatic brain injury Intensive care units Hospital-acquired pneumoniae Ventilator-associated tracheobronchitis Ventilator-associated pneumoniae |
Rights and permissions | |
![]() |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |