Lower Respiratory Tract Infection and Short-Term Outcome in Patients With Acute Respiratory Distress Syndrome
Zampieri, Fernando G. (Hospital do Coração, São Paulo, Brazil)
Póvoa, Pedro (Nova Medical School, CEDOC, New University of Lisbon, Lisbon, Portugal)
Salluh, Jorge I. (Programa de Pós-graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio Janeiro, Brazil)
Rodríguez, Alejandro (Hospital Universitari Joan XXIII de Tarragona)
Valade, Sandrine (Intensive Care Unit, Saint-Louis University Hospital, AP-HP and Paris-Diderot University, Sorbonne Paris Cité, Paris, France)
Andrade Gomes, José (Hospital da Luz (Lisboa, Portugal))
Reignier, Jean (Medical ICU, CHU de Nantes, Nantes, France)
Molinos, Elena (Serviço de Medicina Intensiva, Hospital Pedro Hispano, ULS de Matosinhos, Matosinhos, Portugal)
Almirall i Pujol, Jordi (Universitat Autònoma de Barcelona. Departament de Medicina)
Boussekey, Nicolas (Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Chatiliez, Tourcoing, France)
Socias, Lorenzo (Hospital Universitari Son Llàtzer (Palma de Mallorca, Balears))
Ramirez, Paula (Hospital Universitari i Politècnic La Fe (València))
Viana, William N. (Hospital Copa D'Or, Copacabana, Rio de Janeiro, Brazil)
Rouzé, Anahita (University Hospital of Lille (França))
Nseir, Saad (University Hospital of Lille (França))
Martin-Loeches, Ignacio (Welcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland)

Data:	2018
Resum:	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). 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. 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. After controlling for relevant confounders, we could not find an association between occurrence of VA-LRTI and ICU mortality in patients with ARDS.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Acute respiratory distress syndrome ; Ventilator-associated pneumonia ; Critical care
Publicat a:	Journal of Intensive Care Medicine, Vol. 35 (april 2018) , p. 588-594, ISSN 1525-1489

DOI: 10.1177/0885066618772498
PMID: 29699468

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