Effect of process of securing airway in head injury patients due to trauma on the occurence of Ventilator associated lung infection

Not yet recruiting

Conditions: Pneumonia in diseases classified elsewhere,

Registration Number: CTRI/2021/01/030581

Lead Sponsor: PGIMER

Brief Summary: Ventilator-associated pneumonia (VAP) is a pneumonia that occurs in a hospitalized patients who have received more than 48 hours of mechanical ventilation (MV), presenting with Xray evidence of new or progressive infiltrate or consolidation, along with associated symptoms, signs and laboratory investigations. The incidence of VAP in traumatic brain injury (TBI) patients was reported to be significantly high , ranging between 24% to 60%and was shown to be associated with early death and higher mortality, especially in patients with a GCS less than or equal to 8. Apart from contributing to a greater proportion of death and disability, the treatment and increased hospital length of stay leads to a significant economic burden worldwide.

Following head injury, a cascade of primary and secondary insults is initiated inducing significant morbidity in these patients. The primary insults include brain parenchyma injury, deranged cerebral metabolism, changes in cerebral blood flow with consequent cerebral edema which cannot be averted.Among the devastating secondary insults, depressed level of consciousness, airway obstruction, inability to clear mucus secretions and loss of protective airway reflexes are potential factors known to increase the risk of aspiration and other pulmonary related complication in critical head injury patients. Of note, a recent data has related trauma induced factors like full stomach, pain, agitation, facio-maxillary injuries, cervical spine immobilization and prehospital airway management as adjunctive causes accounting for early onset pneumonia in patients receiving critical care.

In lower middle income countries like ours, prehospital airway management is negligible and hence on arrival to Emergency Room, the airway characteristics of these TBI patients are mostly compromised. The implications of trauma, prehospital / triage airway management and its association with VAP have not been investigated so far in our settings. Also most of the data in literature on prehospital airway management has been done retrospectively. This study design intends to observe prior airway characteristics and co-relate the incidence of VAP in patients admitted to our trauma intensive care following severe head injury. The diagnosis of VAP follows the American Thoracic Society (ATS) definition and will be confirmed by microbiological culture.

Detailed Description: Not available

Recruitment & Eligibility

Status: Not Yet Recruiting

Sex: All

Target Recruitment: 120

Inclusion Criteria

All patients more than or equal to eighteen years of age admitted with severe TBI (GCS eight or less) Patients with device used to support assist or control respiration by the application of positive pressure to the airway delivered through an artificial airway (oral or nasal endotracheal or tracheostomy tube) Duration of mechanical ventilation in Trauma ICU more than or equal to forty eight hours.

Exclusion Criteria

Patients who expire in less than forty eight hours of mechanical ventilation Patients who refuse consent.

Study & Design

Study Type: Observational

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
To co-relate characteristics of prior airway management (pre-hospital and in-hospital at triage/operation theatre/ward) with development of Ventilator Associated Pneumonia (for the time the patient is admitted in ICU) in patients with severe Traumatic Brain Injury receiving critical care	Daily, till discharge of patient from ICU

Secondary Outcome Measures

Name	Time	Method
1.Days of mechanical ventilation	2.ICU length of stay

Trial Locations

Locations (1): Post Graduate Institute of Medical Education and Research, Chandigarh
🇮🇳
Chandigarh, CHANDIGARH, India
Post Graduate Institute of Medical Education and Research, Chandigarh
🇮🇳Chandigarh, CHANDIGARH, India
Dr Mahizhan K A
Principal investigator
9489810511
mahizhan2014@gmail.com