Abstract
Background
Prehospital airway management in severe traumatic brain injury (TBI) is widely recommended
by international guidelines for the management of trauma. Early-onset ventilator-associated
pneumonia (EOVAP) is a common occurrence in this population and can worsen mortality
and functional outcome.
Objectives
In this retrospective observational study, we aimed to evaluate the association between
different prehospital airway management variables and the occurrence of EOVAP. Secondarily
we evaluated the correlation between EOVAP and mortality and neurological outcome.
Methods
The study retrospectively evaluated 223 patients admitted from 2010 to 2017 in our
trauma intensive care unit for severe TBI. The population was divided into three groups
on the basis of the airway management technique adopted (bag mask ventilation, laryngeal
tube, orotracheal intubation). Uni- and multivariate logistic regression analyses
were performed using the occurrence of EOVAP as the dependent variable, to investigate
potential associations with prehospital airway management.
Results
A total of 131 episodes (58.7%) of EOVAP were registered in the study population (223
patients). Laryngeal tube and orotracheal intubation were used in patients with significantly
lower Glasgow Coma Scale score on scene and a higher Face Abbreviated Injury Scale;
advanced airway management significantly increased the total rescue time. The prehospital
airway management technique adopted, prehospital type of sedation or use of muscle
relaxants, type of transport, and rescue times were not associated with the occurrence
of EOVAP.
Conclusions
Prehospital airway management does not have a significant impact on the occurrence
of EOVAP in severe TBI patients. Similarly, it does not have a significant impact
on mortality or long-term neurological outcome despite increasing duration of mechanical
ventilation, intensive care unit, and hospital stay.
Keywords
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Article info
Publication history
Published online: April 15, 2019
Accepted:
February 2,
2019
Received in revised form:
January 22,
2019
Received:
July 20,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
