Infection prophylaxis in severe brain injuries: emphasis on ventilator-associated pneumonia and external ventricular drainage

L.A. Maltseva, V.I. Grishin, L.V. Kunik, D.V. Bazylenko, S.O. Pshenko

Abstract


Ventilator-associated pneumonia in patients with severe traumatic brain injury can be up to 40 % and this is largely due to the prolonged exposure to mechanical ventilation. The presence of ventilator-associated pneumonia compounds the severity of the disease, which is associated with the factors such as hypoxia, fever, hypotension, increased intracranial pressure. Patients with invasive monitoring of intracranial pressure are at high risk of infection, which is 27 %. The article, based on the position of Guidelines for Management of Severe Traumatic Brain Injury 4th Edition, 2016 provides evidence on the prevention of infection risks associated with ventilator-associated pneumonia and external ventricular drain. Concerning ventilator-associa­ted pneumonia three positions were analyzed: the first estimated the time of overlay of tracheostomy (early, late); second one evaluated oral care with povidone-iodine; in the third there were estimated the infection prevention methods associated with the systems for external ventricular drain, by impregnating the catheters with antibiotics. The analysis found that early tracheostomy is recommended to reduce the days of mechanical ventilation, when the total benefits significantly outweigh the complications associated with this procedure. However, there is no evidence that early tracheostomy reduces mortality or incidence of nosocomial pneumonia. The use of povidone-iodine for the purpose of oral care in order to reduce the incidence of ventilator-associated pneumoniais not recommended and may lead to increased risk of developing acute respiratory distress syndrome. Catheters for external ventricular drainage, impregnated with antibiotic, may be considered for the prevention of catheter-related infections in the external ventricular drainage.

Keywords


severe brain injury; ventilator-associated pneumonia; intracranial pressure; invasive monitoring; infection prophylaxis; review

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DOI: https://doi.org/10.22141/2224-0586.3.82.2017.102328

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