Risk factors and outcomes of ventilator-associated pneumonia in patients with traumatic brain injury: a systematic review and meta-analysis

Prieto-Alvarado, Diego Enrique; Parada-Gereda, Henry M.; Molano Franco, Daniel; Martinez, Yamil Liscano; Rivas Tafurt, Giovanna Patricia; Masclans Enviz, Joan Ramon

doi:http://dx.doi.org/10.1016/j.jcrc.2024.154922

Risk factors and outcomes of ventilator-associated pneumonia in patients with traumatic brain injury: a systematic review and meta-analysis

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Prieto-Alvarado DE, Parada-Gereda HM, Molano D, Martinez YL, Rivas Tafurt GP, Masclans JR. Risk factors and outcomes of ventilator-associated pneumonia in patients with traumatic brain injury: a systematic review and meta-analysis. J Crit Care. 2025;85:154922. DOI: 10.1016/j.jcrc.2024.154922

Abstract

Background: Ventilator-associated pneumonia (VAP) is a common complication in traumatic brain injury (TBI) patients, which increases morbidity and negatively affects outcomes. Risk factors and outcomes in these patients remain controversial. The aim of the present study is to explore the risk factors and clinical outcomes of patients with VAP and TBI. Methods: Two researchers conducted independent systematic literature searches of Pubmed, Cochrane Database, Scopus, Medline Ovid, Science Direct databases, published from inception to January 2024. The Newcastle-Ottawa scale was used to assess study quality. A meta-analysis was performed using a random-effects model when heterogeneity I2 > 50 % and a fixed-effects model when I2 < 50 %; in addition, a subgroup analysis was performed to explore VAP risk factors, and publication bias was assessed with the funnel plot and Begg's and Egger's tests. All results were considered statistically significant when p < 0.05. The certainty of the evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. Results: Twelve studies were included in the meta-analysis with a total of 2883 patients. Male gender [OR 1.58 (95 % CI 1.23, 2.02) p < 0.05 I2 0 %] and abbreviated injury scale (head: H-AIS) [≥ 3 OR 2.79 (95 % CI 1.58, 4.93) p < 0.05 I2 0 %] increased the risk of VAP. After subgroup analysis, blood transfusion on admission [OR 1.97 (95 % CI 1.16-3.35) p ≤0.05 I2 5 %] and barbiturate infusion [OR 3.55 (95 % CI 2.01-6.30) p ≤0.05 I2 0 %] became risk factors. Prophylactic antibiotic use [OR 0.67 (95 % CI 0.51-0.88) p ≤0.05 I2 0 %] and younger age MD -3.29 (95 % CI -5.18, -1.40) p ≤0.05 I2 41 %] emerged as significant protective factors. In VAP patients ICU stay [MD 7.02 (95 % CI 6.05-7.99) p ≤0.05 I2 37 %], duration of mechanical ventilation [MD 5.79 (95 % CI 4.40, 7.18) p ≤0.05 I2 79 %] and hospital stay [MD 11.88 (95 % CI 8.71-15.05) p ≤0.05 I2 0 %] were significantly increased. The certainty of the evidence was moderate-high for the outcomes studied. Conclusions: Male gender, H-AIS ≥ 3, blood transfusion on admission, and barbiturate infusion were risk factors for VAP. In patients with VAP, ICU stay, duration of mechanical ventilation, hospital stay were significantly increased.