Ceftriaxone for all vented brain injured patients? (PROPHY-VAP)
Patients with strokes and traumatic brain injuries who require mechanical ventilation due to coma are at very high risk for developing ventilator associated pneumonia. Prophylactic antibiotics, given enterally or intravenously, have been shown to reduce the rate of VAP, but with unproven clinically meaningful benefits like survival. Secondary consequences of prophylaxis, such as induction of antimicrobial resistance, have also been underexplored in short-term studies limited to a few centers at a time. The uncertainty of benefits and harms have together limited the use of antimicrobial prophylaxis against VAP, and professional societies haven’t endorsed the practice.
At eight ICUs in France, authors randomized 345 patients receiving mechanical ventilation for coma due to brain injuries (~40% with subarachnoid hemorrhages, ~22% intracerebral hemorrhages, ~28% traumatic brain injuries) to receive either ceftriaxone prophylaxis (2 grams IV as a single dose) or saline placebo. The diagnosi…
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