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Critical Care
Published in: Critical Care 2/2012

Open Access 01-04-2012 | Research

Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy

Authors: Jean-Marie Forel, François Voillet, Daniel Pulina, Arnaud Gacouin, Gilles Perrin, Karine Barrau, Samir Jaber, Jean-Michel Arnal, Mohamed Fathallah, Pascal Auquier, Antoine Roch, Elie Azoulay, Laurent Papazian

Published in: Critical Care | Issue 2/2012

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Abstract

Introduction

Ventilator-associated pneumonia (VAP) may contribute to the mortality associated with acute respiratory distress syndrome (ARDS). We aimed to determine the incidence, outcome, and risk factors of bacterial VAP complicating severe ARDS in patients ventilated by using a strictly standardized lung-protective strategy.

Methods

This prospective epidemiologic study was done in all the 339 patients with severe ARDS included in a multicenter randomized, placebo-controlled double-blind trial of cisatracurium besylate in severe ARDS patients. Patients with suspected VAP underwent bronchoalveolar lavage to confirm the diagnosis.

Results

Ninety-eight (28.9%) patients had at least one episode of microbiologically documented bacterial VAP, including 41 (41.8%) who died in the ICU, compared with 74 (30.7%) of the 241 patients without VAP (P = 0.05). After adjustment, age and severity at baseline, but not VAP, were associated with ICU death. Cisatracurium besylate therapy within 2 days of ARDS onset decreased the risk of ICU death. Factors independently associated with an increased risk to develop a VAP were male sex and worse admission Glasgow Coma Scale score. Tracheostomy, enteral nutrition, and the use of a subglottic secretion-drainage device were protective.

Conclusions

In patients with severe ARDS receiving lung-protective ventilation, VAP was associated with an increased crude ICU mortality which did not remain significant after adjustment.
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Literature
1.
Bregeon F, Ciais V, Carret V, Gregoire R, Saux P, Gainnier M, Thirion X, Drancourt M, Auffray JP, Papazian L: Is ventilator-associated pneumonia an independent risk factor for death? Anesthesiology 2001, 94: 554-560. 10.1097/00000542-200104000-00005CrossRefPubMed
2.
Fagon J, Chastre J, Hance A, Montravers P, Novara A, Gibert C: Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993, 94: 281-288. 10.1016/0002-9343(93)90060-3CrossRefPubMed
3.
Papazian L, Bregeon F, Thirion X, Gregoire R, Saux P, Denis J, Perin G, Charrel J, Dumon J, Affray J, Gouin F: Effect of ventilator-associated pneumonia on mortality and morbidity. Am J Respir Crit Care Med 1996, 154: 91-97.CrossRefPubMed
4.
Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, Reinhart K: International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009, 302: 2323-2329. 10.1001/jama.2009.1754CrossRefPubMed
5.
Iregui MG, Kollef MH: Ventilator-associated pneumonia complicating the acute respiratory distress syndrome. Seminars in respiratory and critical care medicine 2001, 22: 317-326. 10.1055/s-2001-15788CrossRefPubMed
6.
Chastre J, Trouillet JL, Vuagnat A, Joly-Guillou ML, Clavier H, Dombret MC, Gibert C: Nosocomial pneumonia in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 1998, 157: 1165-1172.CrossRefPubMed
7.
Delclaux C, Roupie E, Blot F, Brochard L, Lemaire F, Brun-Buisson C: Lower respiratory tract colonization and infection during severe acute respiratory distress syndrome: incidence and diagnosis. Am J Respir Crit Care Med 1997, 156: 1092-1098.CrossRefPubMed
8.
Markowicz P, Wolff M, Djedaini K, Cohen Y, Chastre J, Delclaux C, Merrer J, Herman B, Veber B, Fontaine A, Dreyfuss D: Multicenter prospective study of ventilator-associated pneumonia during acute respiratory distress syndrome. Incidence, prognosis, and risk factors. ARDS Study Group. Am J Respir Crit Care Med 2000, 161: 1942-1948.CrossRefPubMed
9.
Sutherland KR, Steinberg KP, Maunder RJ, Milberg JA, Allen DL, Hudson LD: Pulmonary infection during the acute respiratory distress syndrome. Am J Respir Crit Care Med 1995, 152: 550-556.CrossRefPubMed
10.
Meduri GU, Reddy RC, Stanley T, El-Zeky F: Pneumonia in acute respiratory distress syndrome. A prospective evaluation of bilateral bronchoscopic sampling. Am J Respir Crit Care Med 1998, 158: 870-875.CrossRefPubMed
11.
Pugin J, Dunn-Siegrist I, Dufour J, Tissieres P, Charles PE, Comte R: Cyclic stretch of human lung cells induces an acidification and promotes bacterial growth. Am J Respir Cell Mol Biol 2008, 38: 362-370.CrossRefPubMed
12.
Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, Jaber S, Arnal JM, Perez D, Seghboyan JM, Constantin JM, Courant P, Lefrant JY, Guerin C, Prat G, Morange S, Roch A: Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 2010, 363: 1107-1116. 10.1056/NEJMoa1005372CrossRefPubMed
13.
Michel F, Franceschini B, Berger P, Arnal JM, Gainnier M, Sainty JM, Papazian L: Early antibiotic treatment for BAL-confirmed ventilator-associated pneumonia: a role for routine endotracheal aspirate cultures. Chest 2005, 127: 589-597. 10.1378/chest.127.2.589CrossRefPubMed
14.
Bregeon F, Papazian L, Thomas P, Carret V, Garbe L, Saux P, Drancourt M, Auffray JP: Diagnostic accuracy of protected catheter sampling in ventilator-associated bacterial pneumonia. Eur Respir J 2000, 16: 969-975. 10.1183/09031936.00.16596900CrossRefPubMed
15.
Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia Am J Respir Crit Care Med 2005, 171: 388-416.
16.
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network N Engl J Med 2000, 342: 1301-1308.
17.
de Wreede LC, Fiocco M, Putter H: The mstate package for estimation and prediction in non- and semi-parametric multi-state and competing risks models. Computer methods and programs in biomedicine 2010, 99: 261-274. 10.1016/j.cmpb.2010.01.001CrossRefPubMed
18.
Putter H, Fiocco M, Geskus RB: Tutorial in biostatistics: competing risks and multi-state models. Statistics in medicine 2007, 26: 2389-2430. 10.1002/sim.2712CrossRefPubMed
19.
Combes A, Luyt CE, Trouillet JL, Nieszkowska A, Chastre J: Gender impact on the outcomes of critically ill patients with nosocomial infections. Crit Care Med 2009, 37: 2506-2511. 10.1097/CCM.0b013e3181a569dfCrossRefPubMed
20.
Federman DD: The biology of human sex differences. N Engl J Med 2006, 354: 1507-1514. 10.1056/NEJMra052529CrossRefPubMed
21.
Hubacek JA, Stuber F, Frohlich D, Book M, Wetegrove S, Ritter M, Rothe G, Schmitz G: Gene variants of the bactericidal/permeability increasing protein and lipopolysaccharide binding protein in sepsis patients: gender-specific genetic predisposition to sepsis. Crit Care Med 2001, 29: 557-561. 10.1097/00003246-200103000-00015CrossRefPubMed
22.
Esper AM, Moss M, Lewis CA, Nisbet R, Mannino DM, Martin GS: The role of infection and comorbidity: Factors that influence disparities in sepsis. Crit Care Med 2006, 34: 2576-2582. 10.1097/01.CCM.0000239114.50519.0EPubMedCentralCrossRefPubMed
23.
Valentin A, Jordan B, Lang T, Hiesmayr M, Metnitz PG: Gender-related differences in intensive care: a multiple-center cohort study of therapeutic interventions and outcome in critically ill patients. Crit Care Med 2003, 31: 1901-1907. 10.1097/01.CCM.0000069347.78151.50CrossRefPubMed
24.
Craven DE, Kunches LM, Kilinsky V, Lichtenberg DA, Make BJ, McCabe WR: Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 1986, 133: 792-796.PubMed
25.
Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, Jaeschke RZ, Brun-Buisson C: Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998, 129: 433-440.CrossRefPubMed
26.
Magret M, Amaya-Villar R, Garnacho J, Lisboa T, Diaz E, Dewaele J, Deja M, Manno E, Rello J: Ventilator-associated pneumonia in trauma patients is associated with lower mortality: results from EU-VAP study. J Trauma 2010, 69: 849-854. 10.1097/TA.0b013e3181e4d7beCrossRefPubMed
27.
Esperatti M, Ferrer M, Theessen A, Liapikou A, Valencia M, Saucedo LM, Zavala E, Welte T, Torres A: Nosocomial pneumonia in the intensive care unit acquired during mechanical ventilation or not. Am J Respir Crit Care Med 2010, 182: 1533-1539. 10.1164/rccm.201001-0094OCCrossRefPubMed
28.
Ewig S, Torres A, El-Ebiary M, Fabregas N, Hernandez C, Gonzalez J, Nicolas JM, Soto L: Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury. Incidence, risk factors, and association with ventilator-associated pneumonia. Am J Respir Crit Care Med 1999, 159: 188-198.CrossRefPubMed
29.
Rello J, Torres A, Ricart M, Valles J, Gonzalez J, Artigas A, Rodriguez-Roisin R: Ventilator-associated pneumonia by Staphylococcus aureus. Comparison of methicillin-resistant and methicillin-sensitive episodes. Am J Respir Crit Care Med 1994, 150: 1545-1549.CrossRefPubMed
30.
Da Silva PS, Neto HM, de Aguiar VE, Lopes E Jr, de Carvalho WB: Impact of sustained neuromuscular blockade on outcome of mechanically ventilated children. Pediatr Int 2010, 52: 438-443. 10.1111/j.1442-200X.2010.03104.xCrossRefPubMed
31.
Leone M, Delliaux S, Bourgoin A, Albanese J, Garnier F, Boyadjiev I, Antonini F, Martin C: Risk factors for late-onset ventilator-associated pneumonia in trauma patients receiving selective digestive decontamination. Intensive Care Med 2005, 31: 64-70. 10.1007/s00134-004-2514-zCrossRefPubMed
Metadata
Title
Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy
Authors
Jean-Marie Forel
François Voillet
Daniel Pulina
Arnaud Gacouin
Gilles Perrin
Karine Barrau
Samir Jaber
Jean-Michel Arnal
Mohamed Fathallah
Pascal Auquier
Antoine Roch
Elie Azoulay
Laurent Papazian
Publication date
01-04-2012
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2012
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc11312

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