Neurosurgery notes/Trauma/Management of trauma/Non surgical/Infection

Infection

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Non surgical
Infection prophylactic
  • Severe traumatic brain injury can increase a patient’s susceptibility to infection because of necessary mechanical ventilation to prevent airway obstruction, aspiration, and consequential hypoxia, in addition to invasive monitoring.
  • Infection risks from
    • Ventilator associated pneumonias (VAP)
      • CDC definition: possible VAP requires a positive culture, purulent respiratory secretions, or positive results on one of several tests.
      • VAP in patients with TBI may be as high as 40%,
      • VAP strongly associated with longer exposure to mechanical ventilation.
      • The occurrence of VAP represents a significant morbidity and is associated with factors such as hypoxia, fevers, hypotension, and increased ICP, known to worsen the TBI patient’s hospital course.
      • Early tracheostomy is recommended to reduce mechanical ventilation days when the overall benefit is felt to outweigh the complications associated with such a procedure.
        • However, there is no evidence that early tracheostomy reduces mortality or the rate of nosocomial pneumonia.
      • The use of povidone-iodine (PI) oral care is not recommended to reduce ventilator associated pneumonia and may cause an increased risk of acute respiratory distress syndrome.
    • Central line-associated bacteremias
    • Intracranial pressure (ICP) monitoring
      • Are reported to have related infection rates as high as 27%.
    • EVDs
      • The historic focus of routine catheter exchanges has been replaced by attention to proper care during insertion, cerebrospinal fluid (CSF) sampling techniques
      • The question of whether prophylactic intravenous (IV) antibiotics reduces infection rates or increases the risk for emergence of drug-resistant organisms.