Abstract
Background
Pulmonary infection is common yet serious complication in patients with severe traumatic brain injury (STBI). We aimed to evaluate the predicators of pulmonary infection in STBI patients undergoing tracheostomy, to provide evidence for the clinical nursing care of STBI patients.
Methods
This study was a retrospective cohort design. STBI patients undergoing tracheostomy treatment from January 1, 2019 to August 31, 2021 in our hospital were included. The characteristics of pulmonary infection and no pulmonary infection patients were analyzed.
Results
A total 216 STBI patients undergoing tracheostomy were included, the incidence of pulmonary infection was 26.85%. Diabetes (r = 0.782), hypoproteinemia (r = 0.804), duration of coma(r = 0.672), duration of mechanical ventilation(r = 0.724) and length of hospital stay (r = 0.655), length of hospital stay post tracheostomy (r = 0.554), mortality (r = 0.598) were all correlated with pulmonary infection (all p < 0.05). Klebsiella pneumoniae (33.87%) and Staphylococcus aureus (29.03%) were the most commonly seen pathogens in the pulmonary infection of TBI patients. Logistic regression analyses indicated that diabetes (OR 2.232, 95% CI 1.215–3.904), hypoproteinemia with plasma total protein < 60 g/L (OR 1.922, 95% CI 1.083–3.031), duration of coma ≥ 22 h (OR 2.864, 95% CI 1.344–5.012), duration of mechanical ventilation ≥ 5 days (OR 3.602, 95% CI 1.297–5.626), length of hospital stay ≥ 21 days (OR 2.048, 95% CI 1.022–3.859) were the risk factors of pulmonary infection in TBI patients undergoing tracheostomy (all p < 0.05).
Conclusions
Further investigations on the early preventions and treatments targeted on those risk factors are needed to reduce the pulmonary infection in clinical practice.
Similar content being viewed by others
Background
Severe traumatic brain injury (STBI) is one of the most important causes of death and disability worldwide [1]. Studies [2,3,4] have found that organ failure and secondary infection after brain trauma are the most important causes of death. The literature reports [5, 6] a fatality rate that can reach 50.17%, and the concurrent pulmonary infection rate can be as high as 60.84%. STBI patients are prone to secondary pulmonary infection, which can significantly increase the disability and mortality of patients [7, 8]. Therefore, early prediction, diagnosis and early intervention of whether STBI patients have secondary pulmonary infection can help to reduce the mortality of patients and improve the prognosis of patients.
During the treatment of STBI, tracheostomy is often used to provide respiratory support in patients with craniocerebral injury [9]. However, tracheostomy is a traumatic operation, which destroys the body barrier of the patient’s respiratory system and it usually takes a long treatment period [8, 10, 11]. Therefore, the STBI patients are more prone to pulmonary infection [12]. Currently, the characteristics of pulmonary infection in STBI patients undergoing tracheostomy remains unclear [13]. Identifying the risk factors of pulmonary infection in STBI patients undergoing tracheostomy is beneficial to the counteractive measures making to reduce pulmonary infection which will impact on the management and treatment of STBI. Therefore, in this present study, we aimed to analyze the characteristics of pulmonary infection in STBI patients undergoing tracheostomy, to identify the potential influencing factors of pulmonary infections, thereby providing reliable evidences into the clinical STBI treatment.
Methods
Ethical considerations
In this study, all methods were performed according to the relevant guidelines and regulations. This present study was a retrospective cohort design. And the study had been approved by the ethical committee of First Affiliated Hospital of Soochow University (approval number: 2019-200), and written informed consents had been obtained from all the included patients or related guardians of patient.
Patients
This study selected STBI patients who underwent tracheostomy in the department of neurosurgery of our hospital from January 1, 2019 to August 31, 2021 as study population. The inclusion criteria were: patients with TBI and a Glasgow Coma Scale (GCS) ≤ 8 points at admission; STBI patients who received tracheostomy treatment during the hospital stay; and patients with duration of mechanical ventilation > 48 h. The exclusion criteria of this study are: patients whose condition deteriorated rapidly and died within 24 h of admission; Patients with pulmonary infection diagnosed by the respiratory symptoms, blood gas analysis and lung X-rays at the admission of patients; patients whose relatives did not agree to participate in this study.
Diagnostic criteria for pulmonary infection
We focused on the pulmonary infection in STBI patients undergoing tracheostomy, which should be a part of hospital-acquired pneumonia. The diagnosis of pulmonary infection during hospital stay was referred to the relevant diagnostic criteria for pulmonary infection [14,15,16], specifically as following: ① The patient had respiratory symptoms such as cough, excessive sputum, purulent sputum, rapid breathing, fever; ② body temperature ≥ 38 °C; ③ the white blood cell > 10 × 109; ④ Auscultation of the lungs could hear dry and wet rales; ⑤ X-rays or chest CT of lungs indicated small patchy shadows; ⑥ Pathogenic bacteria cultured in sputum; ⑦ Patients have history of tracheostomy or intubation, aspiration, pulmonary edema, atelectasis, shock, surgical anesthesia, invasive infection of the wound, suppurative thrombophlebitis. Patients can be diagnosed with pulmonary infection if they meet at least 4 items above.
Bacteriological analysis
We analyzed the bacteria and fungi in the bacteriological detections. We used the Microstation automatic microbial identification system (X900) produced by Henrui Biolog company (Nanjing, China) and related media to configure the bacterial suspension for the identification of pathogenic bacteria, which could automatically generate identification results. Sputum culture device were used to suck the deep secretions of lower respiratory tract through tracheal cannula and immediately sent to our laboratory for bacteria culture and drug sensitivity test. The operation process and the collection of sputum specimens were strictly performed in accordance with the principle of sterility.
Data collection
We retrospectively collected following data from the medical record: gender, age, body mass index (BMI), alcohol drinking, smoking, hypertension, diabetes, hyperlipidemia, hypoproteinemia (plasma total protein < 60 g/L), types of TBI, GCS at admission, duration of coma, duration of mechanical ventilations, length of hospital stay and mortality. The characteristics of pulmonary infection and no pulmonary infection patients were compared.
Statistical analysis
We used SPSS 19.0 software to analyze the data. For normally distributed data, we used mean and standard deviation, whereas for non parametric we used median and inter-quartile range (IQR). Comparison between groups was performed by t test. Categorical variables were presented as cases or percentage (%), the group comparisons were performed by chi-square test. Pearson correlation analyses were conducted to assess the correlation of characteristics and pulmonary infection. Logistic regression analyses were conducted to analyze the risk factors related to the occurrence of pulmonary infection. In this study, P < 0.05 was considered statistically significant.
Results
The characteristics of included patients
A total 216 STBI patients undergoing tracheostomy were included, of whom 58 patients had pulmonary infection, the incidence of pulmonary infection was 26.85%. As presented in Table 1, there were significant differences in the diabetes, hypoproteinemia, duration of coma, duration of mechanical ventilation and length of hospital stay, length of hospital stay post tracheostomy, mortality between pulmonary infection and no pulmonary infection group (all p < 0.05). No significant differences in the gender, age, BMI, alcohol drinking, smoking, hypertension, hyperlipidemia, types of TBI, GCS at admission and duration of mechanical ventilation prior to tracheostomy were found (all p > 0.05).
Correlation analysis
As indicated in Table 2, Pearson correlation analyses indicated that diabetes (r = 0.782), hypoproteinemia (r = 0.804), duration of coma (r = 0.672), duration of mechanical ventilation (r = 0.724) and length of hospital stay (r = 0.655), length of hospital stay post tracheostomy (r = 0.554), mortality (r = 0.598) were all correlated with pulmonary infection (all p < 0.05).
Distribution of pathogens
Table 3 indicated the distribution of pathogens of pulmonary infection in STBI patients, Klebsiella pneumonia (33.87%) and Staphylococcus aureus (29.03%) were most commonly seen pathogens in the pulmonary infection of TBI patients.
Resistant rate and antibiotic sensitivity of Klebsiella pneumoniae and Staphylococcus aureus
Table 4 indicated the resistant rate and antibiotic sensitivity of Klebsiella pneumoniae and Staphylococcus aureus to antibiotics. Both Klebsiella pneumoniae Staphylococcus aureus were highly sensitive to Cefoperazone, Meropenem, and Levofloxacin.
The risk factors of pulmonary infection in TBI patients undergoing tracheostomy
The variable assignment of multivariate logistic regression in this present study were presented in Table 5. As showed in Table 6, the logistic regression analyses indicated that diabetes (OR 2.232, 95% CI 1.215–3.904), hypoproteinemia (OR 1.922, 95% CI 1.083–3.031), duration of coma ≥ 22 h (OR 2.864, 95% CI 1.344–5.012), duration of mechanical ventilation ≥ 5 days (OR 3.602, 95% CI 1.297–5.626), length of hospital stay ≥ 21 days (OR 2.048, 95% CI 1.022–3.859) were the risk factors of pulmonary infection in TBI patients undergoing tracheostomy (all p < 0.05).
Discussions
STBI is one of the clinical critical illnesses, which can lead to a higher disability rate and fatality rate. In clinical practice, tracheostomy may reduce the risk of VAP, avoid the complications of prolonged ventilation, and it helps in weaning patients from the ventilator if they are on the ventilator for a prolonged period. However, tracheostomy is one of the high-risk factors for pulmonary infection [17, 18]. However, if patients with TBI are complicated with pulmonary infections, it may further affect their recovery effect and prognosis, and even lead to an increase in their mortality [19]. Therefore, it is very important for such patients to prevent and control pulmonary infections [20, 21]. To achieve effective control and treatment, a comprehensive understanding of associated factors is necessary for the prevention and treatment of pulmonary infection. The results of this study have showed that the incidence of pulmonary infection is 26.85% in STBI patients undergoing tracheostomy. Diabetes, hypoproteinemia, duration of coma ≥ 22 h, duration of mechanical ventilation ≥ 5 days, length of hospital stay ≥ 21 days are the risk factors of pulmonary infection, early preventions and interventions targeted on those risk factors are needed in clinical tracheostomy nursing care.
After tracheostomy, the gas is not humidified and filtered by the upper respiratory tract thus entering the lungs directly, causing possible damage to the ciliary epithelium of the respiratory tract mucosa with difficult removal of secretions and foreign bodies [22, 23]. The patients included in this study received mechanical ventilation after tracheostomy performance, thus receiving active or passive humidification of the airways. The factors that dry inhaled air, blockage of sputum, pathogenic bacteria and particles with pathogenic bacteria make it easy to cause pulmonary infection [24]. At the same time, patients with impaired consciousness who are not ventilated initially post STBI will be vulnerable or prone to aspiration of stomach contents, and digestive juice damages the bronchial mucosa and cilia and may predispose to infection and a picture of pneumonitis [25, 26]. Patients with impaired consciousness are prone to aspiration of stomach contents, and digestive juice damages the bronchial mucosa and cilia and causes infection [27]. In addition, patients with STBI often have stress ulcers, poor gastrointestinal function, malnutrition, which is associated with the occurrence of pulmonary infection [28].
The immune status and body repair ability of diabetic patients are worse than those of no diabetic patients, and the risk of infection is higher [29, 30]. Therefore, intervention on the immune status and blood sugar of diabetic patients should be strengthened [31]. Besides, the longer the coma, the higher risk of pulmonary infection, which is related to the worse immune status [32]. The decline in pulmonary function is also an important reason for the infection [33]. Therefore, interventions in the respiratory tract should be strengthened. People with chronic underlying diseases have relatively poor overall body status, and have poor resistance and repair ability to pathogenic bacteria, so they are more prone to pulmonary infections [34]. Therefore, in addition to the necessary adjustments to the immune status of such patients, close monitoring of blood glucose fluctuations and intensified respiratory management are necessary treatments [35].
In this study, the sputum of patients was cultured and identified, and the types and distribution of pathogens were analyzed. The research results show that gram-negative bacteria are still the first pathogens of lung infections, second by gram-positive bacteria and fungi, suggesting that pathogen monitoring should be strengthened and targeted medications should be given during treatment. Due to long-term exposure to tracheostomy and disease stress, the patient’s immunity is significantly reduced, resulting in a significant increase in the patient’s pulmonary infection rate, and the types of infections are gradually diversified. We have found that Klebsiella pneumoniae and Staphylococcus aureus were most commonly seen pathogens in the pulmonary infection of TBI patients, both Klebsiella pneumoniae and Staphylococcus aureus are highly sensitive to Cefoperazone, Meropenem, and Levofloxacin. Therefore, clinical antibiotics should be given according to the drug resistance and sensitivity assessment, to improve the effects and safety of treatment [36, 37].
Pulmonary infection seriously affects the prognosis of patients with STBI, and infection should be prevented and controlled in a timely and effective manner [38]. The clinical treatment and nursing operations should strictly abide by the aseptic operating procedures, including tracheostomy, dressing change, and tracheal tube care throughout the entire process. Meanwhile, sputum bacteria culture + drug susceptibility test should be carried out in time, antibiotics should be adjusted in time according to the test results, and the collection of sputum specimens should avoid contamination that affects the test results and delays treatment [39]. Suction sputum in time, try to avoid infection around the tracheal incision and damage to the mucous membrane of the respiratory tract to reduce bacterial migration [40, 41]. Besides, adopt a reasonable posture, turn over and pat the back on time to avoid sputum accumulation is helpful to prevent pneumonia [42,43,44]. Furthermore, early nutritional supports are needed, and if necessary, infusion of plasma or albumin to improve the body's resistance to prevent and reduce the chance of nosocomial infection [45].
Several limitations in this present study must be considered. Firstly, our study is a retrospective study design, the collected data are very limited, there can be other factors influencing pulmonary infection that we cannot include for analysis. Secondly, even rough the sample size is large enough, it can be underpowered for some factors to detect the group differences, there by potential biases can be existed. Thirdly, the most included STBI were adult patients with age ≥ 18 years, only 4 children with STBI were included in our study, the further stratified analysis of pulmonary infection in the adult and children populations are needed in the future with larger sample size and rigorous design.
Conclusions
In conclusion, we have found that the pulmonary infection is a very common and serious complication in patients undergoing tracheostomy. Diabetes, hypoproteinemia, duration of coma ≥ 22 h, duration of mechanical ventilation ≥ 5 days, length of hospital stay ≥ 21 days are the risk factors of pulmonary infection in those patients. And the pulmonary infections are mainly caused by gram-negative bacteria. Future studies on the effects and safety of timely and effective measures in response to these risk factors to reduce the pulmonary infections and improve the prognosis of STBI patients are needed.
Availability of data and materials
All data generated or analyzed during this study are included in this published article.
Abbreviations
- STBI:
-
Severe traumatic brain injury
- GCS:
-
Glasgow Coma Scale
- BMI:
-
Body mass index
References
Max JE, Troyer EA, Arif H, Vaida F, Wilde EA, Bigler ED, Hesselink JR, Yang TT, Tymofiyeva O, Wade O, et al. Traumatic brain injury in children and adolescents: psychiatric disorders 24 years later. J Neuropsychiatry Clin Neurosci. 2022;34(1):60–7.
Robba C, Bonatti G, Pelosi P, Citerio G. Extracranial complications after traumatic brain injury: targeting the brain and the body. Curr Opin Crit Care. 2020;26(2):137–46.
Kurtz P, Rocha EEM. Nutrition therapy, glucose control, and brain metabolism in traumatic brain injury: a multimodal monitoring approach. Front Neurosci. 2020;14:190.
Li G, Li W, Chen J, Zhao S, Bai Z, Liu Q, Liao Q, He M, Zhuang W, Chen M, et al. Noninvasive real-time assessment of intracranial pressure after traumatic brain injury based on electromagnetic coupling phase sensing technology. BMC Neurol. 2021;21(1):26.
Quinones-Ossa GA, Durango-Espinosa YA, Padilla-Zambrano H, Ruiz J, Moscote-Salazar LR, Galwankar S, Gerber J, Hollandx R, Ghosh A, Pal R, et al. Current status of indications, timing, management, complications, and outcomes of tracheostomy in traumatic brain injury patients. J Neurosci Rural Pract. 2020;11(2):222–9.
Boltzmann M, Schmidt SB, Gutenbrunner C, Krauss JK, Stangel M, Hoglinger GU, Wallesch CW, Rollnik JD. The influence of the CRS-R score on functional outcome in patients with severe brain injury receiving early rehabilitation. BMC Neurol. 2021;21(1):44.
Coritsidis G, Diamond N, Rahman A, Solodnik P, Lawrence K, Rhazouani S, Phalakornkul S. Hypertonic saline infusion in traumatic brain injury increases the incidence of pulmonary infection. J Clin Neurosci. 2015;22(8):1332–7.
Song RR, Tao YF, Zhu CH, Ju ZB, Guo YC, Ji Y. Effects of nasogastric and percutaneous endoscopic gastrostomy tube feeding on the susceptibility of pulmonary infection in long-term coma patients with stroke or traumatic brain injury. Zhonghua Yi Xue Za Zhi. 2018;98(48):3936–40.
Xue H. Multivariate analysis of secondary pulmonary infection in patients with severe craniocerebral injury after emergency treatment. Henan Med Res. 2021;30(30):3–6.
Sun M, Brady RD, Wanrooy B, Mychasiuk R, Yamakawa GR, Casillas-Espinosa PM, Wong CHY, Shultz SR, McDonald SJ. Experimental traumatic brain injury does not lead to lung infection. J Neuroimmunol. 2020;343:577239.
Skaansar O, Tverdal C, Ronning PA, Skogen K, Brommeland T, Roise O, Aarhus M, Andelic N, Helseth E. Traumatic brain injury-the effects of patient age on treatment intensity and mortality. BMC Neurol. 2020;20(1):376.
Gupta M, Yekula A, Barba D, Pannell JS, Tomlin J. Traumatic ischemic injury in a top of the basilar distribution: a case report. BMC Neurol. 2021;21(1):178.
Doran SJ, Henry RJ, Shirey KA, Barrett JP, Ritzel RM, Lai W, Blanco JC, Faden AI, Vogel SN, Loane DJ. Early or late bacterial lung infection increases mortality after traumatic brain injury in male mice and chronically impairs monocyte innate immune function. Crit Care Med. 2020;48(5):e418–28.
MoHotPsRo C. Hospital infection diagnostic criteria. Chin Med J. 2001;22(5):61–7.
Li S, Su J, Sui Q, Wang G. A nomogram for predicting postoperative pulmonary infection in esophageal cancer patients. BMC Pulm Med. 2021;21(1):283.
Aronen M, Viikari L, Kohonen I, Vuorinen T, Hameenaho M, Wuorela M, Sadeghi M, Soderlund-Venermo M, Viitanen M, Jartti T. Respiratory tract virus infections in the elderly with pneumonia. BMC Geriatr. 2019;19(1):111.
Jacovides CL, Ahmed S, Suto Y, Paris AJ, Leone R, McCarry J, Christofidou-Solomidou M, Kaplan LJ, Smith DH, Holena DN, et al. An inflammatory pulmonary insult post-traumatic brain injury worsens subsequent spatial learning and neurological outcomes. J Trauma Acute Care Surg. 2019;87(3):552–8.
Bahloul M, Chelly H, Regaieg K, Rekik N, Bellil S, Chaari A, Bouaziz W, Chabchoub I, Haddar S, Hamida CB, et al. Pulmonary embolism following severe traumatic brain injury: incidence, risk factors and impact outcome. Intensive Care Med. 2017;43(9):1433–5.
Wen Z, Wu C, Cui F, Zhang H, Mei B, Shen M. The role of osmolality in saline fluid nebulization after tracheostomy: time for changing? BMC Pulm Med. 2016;16(1):179.
Kelly SJ, Martinsen P, Tatkov S. Rapid changes in mucociliary transport in the tracheal epithelium caused by unconditioned room air or nebulized hypertonic saline and mannitol are not determined by frequency of beating cilia. Intensive Care Med Exp. 2021;9(1):8.
Beez T, Steiger HJ, Etminan N. Pharmacological targeting of secondary brain damage following ischemic or hemorrhagic stroke, traumatic brain injury, and bacterial meningitis: a systematic review and meta-analysis. BMC Neurol. 2017;17(1):209.
Fernandez-Bussy S, Mahajan B, Folch E, Caviedes I, Guerrero J, Majid A. Tracheostomy tube placement: early and late complications. J Bronchology Interv Pulmonol. 2015;22(4):357–64.
Gosling AF, Bose S, Gomez E, Parikh M, Cook C, Sarge T, Shaefi S, Leibowitz A. Perioperative considerations for tracheostomies in the era of COVID-19. Anesth Analg. 2020;131(2):378–86.
Angel L, Kon ZN, Chang SH, Rafeq S, Palasamudram Shekar S, Mitzman B, Amoroso N, Goldenberg R, Sureau K, Smith DE, et al. Novel percutaneous tracheostomy for critically Ill patients with COVID-19. Ann Thorac Surg. 2020;110(3):1006–11.
Raimondi N, Vial MR, Calleja J, Quintero A, Cortes A, Celis E, Pacheco C, Ugarte S, Anon JM, Hernandez G, et al. Evidence-based guidelines for the use of tracheostomy in critically ill patients. J Crit Care. 2017;38:304–18.
Siempos II, Ntaidou TK, Filippidis FT, Choi AMK. Effect of early versus late or no tracheostomy on mortality and pneumonia of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis. Lancet Respir Med. 2015;3(2):150–8.
Pandian V, Morris LL, Brodsky MB, Lynch J, Walsh B, Rushton C, Phillips J, Rahman A, DeRose T, Lambe L, et al. Critical care guidance for tracheostomy care during the COVID-19 pandemic: a global, multidisciplinary approach. Am J Crit Care. 2020;29(6):e116–27.
Koltsida G, Konstantinopoulou S. Long term outcomes in chronic lung disease requiring tracheostomy and chronic mechanical ventilation. Semin Fetal Neonatal Med. 2019;24(5):101044.
Witcher KG, Bray CE, Chunchai T, Zhao F, O’Neil SM, Gordillo AJ, Campbell WA, McKim DB, Liu X, Dziabis JE, et al. Traumatic brain injury causes chronic cortical inflammation and neuronal dysfunction mediated by microglia. J Neurosci. 2021;41(7):1597–616.
Abou-El-Hassan H, Dia B, Choucair K, Eid SA, Najdi F, Baki L, Talih F, Eid AA, Kobeissy F. Traumatic brain injury, diabetic neuropathy and altered-psychiatric health: the fateful triangle. Med Hypotheses. 2017;108:69–80.
Zimering MB, Patel D, Bahn G. Type 2 diabetes predicts increased risk of neurodegenerative complications in veterans suffering traumatic brain injury. J Endocrinol Diabetes. 2019;6(3):1–5.
Gilsanz P, Albers K, Beeri MS, Karter AJ, Quesenberry CP Jr, Whitmer RA. Traumatic brain injury associated with dementia risk among people with type 1 diabetes. Neurology. 2018;91(17):e1611–8.
Johnson-Obaseki S, Veljkovic A, Javidnia H. Complication rates of open surgical versus percutaneous tracheostomy in critically ill patients. Laryngoscope. 2016;126(11):2459–67.
DiSilvio B, Young M, Gordon A, Malik K, Singh A, Cheema T. Complications and outcomes of acute respiratory distress syndrome. Crit Care Nurs Q. 2019;42(4):349–61.
Raimondi N, Vial MR, Calleja J, Quintero A, Cortes Alban A, Celis E, Pacheco C, Ugarte S, Anon JM, Hernandez G, et al. Evidence-based guides in tracheostomy use in critical patients. Med Intensiva. 2017;41(2):94–115.
Alastruey-Izquierdo A, Cadranel J, Flick H, Godet C, Hennequin C, Hoenigl M, Kosmidis C, Lange C, Munteanu O, Page I, et al. Treatment of chronic pulmonary aspergillosis: current standards and future perspectives. Respiration. 2018;96(2):159–70.
Feng C, Zhang M, Zhang S, Zhang J, Li C, Zhou J. Therapeutic effects of pentoxifylline on invasive pulmonary aspergillosis in immunosuppressed mice. BMC Pulm Med. 2021;21(1):31.
Pan WG, Chen BC, Li YF, Wu RX, Wang CH. An unusual case of reactivated latent pulmonary cryptococcal infection in a patient after short-term steroid and azathioprine therapy: a case report. BMC Pulm Med. 2021;21(1):76.
Astua AJ, Michaels EK, Michaels AJ. Prone during pandemic: development and implementation of a quality-based protocol for proning severe COVID-19 hypoxic lung failure patients in situationally or historically low resource hospitals. BMC Pulm Med. 2021;21(1):25.
Asemahagn MA. Sputum smear conversion and associated factors among smear-positive pulmonary tuberculosis patients in East Gojjam Zone, Northwest Ethiopia: a longitudinal study. BMC Pulm Med. 2021;21(1):118.
Long SM, Chern A, Feit NZ, Chung S, Ramaswamy AT, Li C, Cooley V, Hill S, Rajwani K, Villena-Vargas J, et al. Percutaneous and open tracheostomy in patients with COVID-19: comparison and outcomes of an institutional series in New York City. Ann Surg. 2021;273(3):403–9.
Mubashir T, Arif AA, Ernest P, Maroufy V, Chaudhry R, Balogh J, Suen C, Reskallah A, Williams GW. Early versus late tracheostomy in patients with acute traumatic spinal cord injury: a systematic review and meta-analysis. Anesth Analg. 2021;132(2):384–94.
Wastfelt M, Cao Y, Strom JO. Predictors of post-stroke fever and infections: a systematic review and meta-analysis. BMC Neurol. 2018;18(1):49.
Rejeski K, Kunz WG, Rudelius M, Bucklein V, Blumenberg V, Schmidt C, Karschnia P, Schoberl F, Dimitriadis K, von Baumgarten L, et al. Severe Candida glabrata pancolitis and fatal Aspergillus fumigatus pulmonary infection in the setting of bone marrow aplasia after CD19-directed CAR T-cell therapy: a case report. BMC Infect Dis. 2021;21(1):121.
Dong M, Zhou Y, Yang J, Yang J, Liao X, Kang Y. Compare the effect of noninvasive ventilation and tracheostomy in critically ill mechanically ventilated neurosurgical patients: a retrospective observe cohort study. BMC Neurol. 2019;19(1):79.
Acknowledgements
None.
Funding
None.
Author information
Authors and Affiliations
Contributions
XZ, MW designed research; XZ, HZ, HS, MW conducted research; XZ, HZ analyzed data; XZ, HS wrote the first draft of manuscript; HS had primary responsibility for final content. All authors read and approved the final manuscript.
Corresponding authors
Ethics declarations
Ethics approval and consent to participate
In this study, all methods were performed in accordance with the relevant guidelines and regulations. This present study had been approved by the ethical committee of First Affiliated Hospital of Soochow University(approval number:11019036), and written informed consents had been obtained from all the included patients or related guardians of patient.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Zhang, X., Zhou, H., Shen, H. et al. Pulmonary infection in traumatic brain injury patients undergoing tracheostomy: predicators and nursing care. BMC Pulm Med 22, 130 (2022). https://doi.org/10.1186/s12890-022-01928-w
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s12890-022-01928-w