Lower Respiratory Tract Infection and Short-Term Outcome in Patients With Acute Respiratory Distress Syndrome.

Abstract

OBJECTIVE:

To assess whether ventilator-associated lower respiratory tract infections (VA-LRTIs) are associated with mortality in critically ill patients with acute respiratory distress syndrome (ARDS).

MATERIALS AND METHODS:

Post hoc analysis of prospective cohort study including mechanically ventilated patients from a multicenter prospective observational study (TAVeM study); VA-LRTI was defined as either ventilator-associated tracheobronchitis (VAT) or ventilator-associated pneumonia (VAP) based on clinical criteria and microbiological confirmation. Association between intensive care unit (ICU) mortality in patients having ARDS with and without VA-LRTI was assessed through logistic regression controlling for relevant confounders. Association between VA-LRTI and duration of mechanical ventilation and ICU stay was assessed through competing risk analysis. Contribution of VA-LRTI to a mortality model over time was assessed through sequential random forest models.

RESULTS:

The cohort included 2960 patients of which 524 fulfilled criteria for ARDS; 21% had VA-LRTI (VAT = 10.3% and VAP = 10.7%). After controlling for illness severity and baseline health status, we could not find an association between VA-LRTI and ICU mortality (odds ratio: 1.07; 95% confidence interval: 0.62-1.83; P = .796); VA-LRTI was also not associated with prolonged ICU length of stay or duration of mechanical ventilation. The relative contribution of VA-LRTI to the random forest mortality model remained constant during time. The attributable VA-LRTI mortality for ARDS was higher than the attributable mortality for VA-LRTI alone.

CONCLUSION:

After controlling for relevant confounders, we could not find an association between occurrence of VA-LRTI and ICU mortality in patients with ARDS.

• Authors: Fernando G Zampieri, Pedro Póvoa, Jorge I Salluh, Alejandro Rodriguez, Sandrine Valade, José Andrade Gomes, Jean Reignier, Elena Molinos, Jordi Almirall, Nicolas Boussekey, Lorenzo Socias, Paula Ramirez, William N Viana, Anahita Rouzé, Saad Nseir, Ignacio Martin-Loeches
• Journal: Journal of intensive care medicine (J Intensive Care Med) Vol. 35 Issue 6 Pg. 588-594 (Jun 2020) ISSN: 1525-1489 [Electronic] United States
• PMID: 29699468 (Publication Type: Journal Article, Observational Study)

Topics

• Aged
• Bronchitis (etiology, mortality)
• Critical Care Outcomes
• Female
• Hospital Mortality
• Humans
• Intensive Care Units
• Logistic Models
• Male
• Middle Aged
• Pneumonia, Ventilator-Associated (etiology, mortality)
• Prospective Studies
• Respiration, Artificial (adverse effects)
• Respiratory Distress Syndrome (therapy)
• Tracheitis (etiology, mortality)