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

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...

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Detalhes bibliográficos
Autores: Zampieri, Fernando G.|||0000-0001-9315-6386, Póvoa, Pedro|||0000-0002-7069-7304, Salluh, Jorge I., Rodríguez, Alejandro, Valade, Sandrine, Andrade Gomes, José, Reignier, Jean, Molinos, Elena, Almirall i Pujol, Jordi|||0000-0002-3821-4341, Boussekey, Nicolas, Socias, Lorenzo, Ramirez, Paula|||0000-0002-7598-3350, Viana, William N., Rouzé, Anahita|||0000-0002-1330-3161, Nseir, Saad|||0000-0002-7618-0357, Martin-Loeches, Ignacio|||0000-0002-5834-4063
Tipo de documento: artigo
Data de publicação:2018
País:España
Recursos:Universitat Autònoma de Barcelona
Repositório:Dipòsit Digital de Documents de la UAB
Idioma:inglês
OAI Identifier:oai:ddd.uab.cat:227913
Acesso em linha:https://ddd.uab.cat/record/227913
https://dx.doi.org/urn:doi:10.1177/0885066618772498
Access Level:Acceso aberto
Palavra-chave:Acute respiratory distress syndrome
Ventilator-associated pneumonia
Critical care
Descrição
Resumo: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.

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