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Effect of a fever control protocol-based strategy on ventilator-associated pneumonia in severely brain-injured patients.

Abstract : IntroductionFever 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.MethodsAn 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.ResultsThe 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.ConclusionFever control in brain-injured patients was a major risk factor for VAP occurrence, particularly when applied for >3 days.
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https://hal-univ-rennes1.archives-ouvertes.fr/hal-01118640
Contributor : Laurent Jonchère <>
Submitted on : Thursday, February 19, 2015 - 3:08:57 PM
Last modification on : Sunday, October 25, 2020 - 6:32:00 AM

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Yoann Launey, Nicolas Nesseler, Audren Le Cousin, Fanny Feuillet, Ronan Garlantezec, et al.. Effect of a fever control protocol-based strategy on ventilator-associated pneumonia in severely brain-injured patients.. Critical Care, BioMed Central, 2014, 18 (6), pp.689. ⟨10.1186/s13054-014-0689-4⟩. ⟨hal-01118640⟩

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