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

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


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. 

Methods: An 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. 

Results: The 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. 

Conclusion: Fever control in brain-injured patients was a major risk factor for VAP occurrence, particularly when applied for >3?days.

Author: Yoann LauneyNicolas NesselerAudren Le CousinFanny FeuilletRonan GarlantezecYannick MallédantPhilippe Seguin
Credits/Source: Critical Care 2014, 18:689