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

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

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish
Pages (from-to)588-594
Number of pages7
JournalJOURNAL OF INTENSIVE CARE MEDICINE
Volume35
Issue number6
Early online date26 Apr 2018
DOIs
Publication statusPublished - 1 Jun 2020

Keywords

  • acute respiratory distress syndrome
  • critical care
  • ventilator-associated pneumonia

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