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    • Incidence Rate and Risk Factors of Ventilator-Associated Pneumonia in Patients with Traumatic Brain Injury: a Systematic Review and Meta-Analysis of Observational Studies

    Sina Chen, Guanchen Gao,Ying Xia,Zhongqi Wu

    JOURNAL OF THORACIC DISEASE（2023）

    Cent South Univ | Danzhou Peoples Hosp | Chengmai Cty Peoples Hosp

    Cited 3|Views9
    Abstract
    Background: Ventilator-associated pneumonia is a common complication of traumatic brain injury (TBI) patients, causing great harm to the life, health and society of patients. It is important to understand the risk factors related to ventilator-associated pneumonia for infection monitoring and control of patients. However, there are still some controversies about the risk factors in previous studies. Therefore, the purpose of this study was to explore the incidence and risk factors of ventilator-associated pneumonia in patients with TBI. Methods: Two independent researchers selected literature collected by systematically searching databases including PubMed, Ovid, Embase, and ScienceDirect using medical subject headings. The primary end points of the included literature were extracted, and the Cochrane Q test and I-2 statistic were used to evaluate the heterogeneity between studies. The random effects model based on the restricted maximum likelihood method and the fixed effects model based on the reverse variance method were used to calculate and combine the relative risk or mean difference of relevant indicators. The publication bias was evaluated with the funnel plot and Egger test. All results were considered statistically significant at P<0.05. Results: A total of 11 articles were included in this study for meta-analysis, and a total of 2,301 patients with TBI were included. The incidence of ventilator-associated pneumonia in TBI patients was approximately 42% (95% CI: 32-53%). Tracheotomy significantly increased the risk of ventilator-associated pneumonia in patients with TBI [relative risk (RR) =3.71; 95% CI: 1.48-6.94; P<0.05]; the use of prophylactic antibiotics could significantly reduce the risk of ventilator-associated pneumonia in patients with TBI. The risk of pneumonia (RR =0.53; 95% CI: 0.18-0.88; P<0.05); compared with female patients, male patients with TBI had a significantly higher risk (about 46%) of ventilator-associated pneumonia (RR =1.46; 95% CI: 1.13-1.79; P<0.05). Conclusions: The risk of ventilator-associated pneumonia in patients with TBI is about 42%. Posttracheotomy and mechanical ventilation are risk factors for ventilator-associated pneumonia, while prophylactic use of antibiotics is a protective factor in the development of ventilator-associated pneumonia.
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    Traumatic brain injury (TBI),ventilator-associated pneumonia,incidence,risk factors
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    【要点】：本文通过系统回顾和荟萃分析探讨了创伤性脑损伤（TBI）患者呼吸机相关肺炎的发病率和风险因素，发现发病率约为42%，气管切开和机械通气是风险因素，预防性使用抗生素为保护因素。
    

    【方法】：采用系统搜索PubMed、Ovid、Embase和ScienceDirect数据库，由两位独立研究者筛选文献，使用Cochrane Q检验和I-2统计评估研究间异质性，采用随机效应模型和固定效应模型计算相关指标的相对风险或平均差异，用漏斗图和Egger检验评估发表偏倚。
    

    【实验】：共纳入11篇文章进行荟萃分析，涉及2,301名TBI患者。通过分析得出，TBI患者呼吸机相关肺炎的发病率约为42%（95% CI: 32-53%），气管切开显著增加TBI患者呼吸机相关肺炎的风险（RR =3.71; 95% CI: 1.48-6.94; P<0.05），预防性抗生素使用可显著降低TBI患者呼吸机相关肺炎的风险（RR =0.53; 95% CI: 0.18-0.88; P<0.05），男性患者相较于女性患者有更高的风险（约46%）发展成呼吸机相关肺炎（RR =1.46; 95% CI: 1.13-1.79; P<0.05）。