Clinical impact of ventilator-associated pneumonia in patients with the acute respiratory distress syndrome: a retrospective cohort study
Abstract Background The clinical impact and outcomes of ventilator-associated pneumonia (VAP) have been scarcely investigated in patients with the acute respiratory distress syndrome (ARDS). Methods Patients admitted over an 18-month period in two intensive care units (ICU) of a university-affiliate...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-03-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-022-00998-7 |
| _version_ | 1818319694012088320 |
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| author | Marc Le Pape Céline Besnard Camelia Acatrinei Jérôme Guinard Maxime Boutrot Claire Genève Thierry Boulain François Barbier |
| author_facet | Marc Le Pape Céline Besnard Camelia Acatrinei Jérôme Guinard Maxime Boutrot Claire Genève Thierry Boulain François Barbier |
| author_sort | Marc Le Pape |
| collection | DOAJ |
| description | Abstract Background The clinical impact and outcomes of ventilator-associated pneumonia (VAP) have been scarcely investigated in patients with the acute respiratory distress syndrome (ARDS). Methods Patients admitted over an 18-month period in two intensive care units (ICU) of a university-affiliated hospital and meeting the Berlin criteria for ARDS were retrospectively included. The association between VAP and the probability of death at day 90 (primary endpoint) was appraised through a Cox proportional hazards model handling VAP as a delay entry variable. Secondary endpoints included (i) potential changes in the PaO2/FiO2 ratio and SOFA score values around VAP (linear mixed modelling), and (ii) mechanical ventilation (MV) duration, numbers of ventilator- and vasopressor-free days at day 28, and length of stay (LOS) in patients with and without VAP (median or absolute risk difference calculation). Subgroup analyses were performed in patients with COVID-19-related ARDS and those with ARDS from other causes. Results Among the 336 included patients (101 with COVID-19 and 235 with other ARDS), 176 (52.4%) experienced a first VAP. VAP induced a transient and moderate decline in the PaO2/FiO2 ratio without increase in SOFA score values. VAP was associated with less ventilator-free days (median difference and 95% CI, − 19 [− 20; − 13.5] days) and vasopressor-free days (− 5 [− 9; − 2] days) at day 28, and longer ICU (+ 13 [+ 9; + 15] days) and hospital (+ 11.5 [+ 7.5; + 17.5] days) LOS. These effects were observed in both subgroups. Overall day-90 mortality rates were 35.8% and 30.0% in patients with and without VAP, respectively (P = 0.30). In the whole cohort, VAP (adjusted HR 3.16, 95% CI 2.04–4.89, P < 0.0001), the SAPS-2 value at admission, chronic renal disease and an admission for cardiac arrest predicted death at day 90, while the COVID-19 status had no independent impact. When analysed separately, VAP predicted death in non-COVID-19 patients (aHR 3.43, 95% CI 2.11–5.58, P < 0.0001) but not in those with COVID-19 (aHR 1.19, 95% CI 0.32–4.49, P = 0.80). Conclusions VAP is an independent predictor of 90-day mortality in ARDS patients. This condition exerts a limited impact on oxygenation but correlates with extended MV duration, vasoactive support, and LOS. |
| first_indexed | 2024-12-13T10:13:11Z |
| format | Article |
| id | doaj.art-a2531af100ae480b908ac9ad2593a1e4 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-13T10:13:11Z |
| publishDate | 2022-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-a2531af100ae480b908ac9ad2593a1e42022-12-21T23:51:23ZengSpringerOpenAnnals of Intensive Care2110-58202022-03-0112111210.1186/s13613-022-00998-7Clinical impact of ventilator-associated pneumonia in patients with the acute respiratory distress syndrome: a retrospective cohort studyMarc Le Pape0Céline Besnard1Camelia Acatrinei2Jérôme Guinard3Maxime Boutrot4Claire Genève5Thierry Boulain6François Barbier7Médecine Intensive-Réanimation, Centre Hospitalier Régional d’OrléansMédecine Intensive-Réanimation, Centre Hospitalier Régional d’OrléansMédecine Intensive-Réanimation, Centre Hospitalier Régional d’OrléansLaboratoire de Bactériologie, Pôle de Biopathologies, Centre Hospitalier Régional d’OrléansRéanimation Chirurgicale, Centre Hospitalier Régional d’OrléansRéanimation Chirurgicale, Centre Hospitalier Régional d’OrléansMédecine Intensive-Réanimation, Centre Hospitalier Régional d’OrléansMédecine Intensive-Réanimation, Centre Hospitalier Régional d’OrléansAbstract Background The clinical impact and outcomes of ventilator-associated pneumonia (VAP) have been scarcely investigated in patients with the acute respiratory distress syndrome (ARDS). Methods Patients admitted over an 18-month period in two intensive care units (ICU) of a university-affiliated hospital and meeting the Berlin criteria for ARDS were retrospectively included. The association between VAP and the probability of death at day 90 (primary endpoint) was appraised through a Cox proportional hazards model handling VAP as a delay entry variable. Secondary endpoints included (i) potential changes in the PaO2/FiO2 ratio and SOFA score values around VAP (linear mixed modelling), and (ii) mechanical ventilation (MV) duration, numbers of ventilator- and vasopressor-free days at day 28, and length of stay (LOS) in patients with and without VAP (median or absolute risk difference calculation). Subgroup analyses were performed in patients with COVID-19-related ARDS and those with ARDS from other causes. Results Among the 336 included patients (101 with COVID-19 and 235 with other ARDS), 176 (52.4%) experienced a first VAP. VAP induced a transient and moderate decline in the PaO2/FiO2 ratio without increase in SOFA score values. VAP was associated with less ventilator-free days (median difference and 95% CI, − 19 [− 20; − 13.5] days) and vasopressor-free days (− 5 [− 9; − 2] days) at day 28, and longer ICU (+ 13 [+ 9; + 15] days) and hospital (+ 11.5 [+ 7.5; + 17.5] days) LOS. These effects were observed in both subgroups. Overall day-90 mortality rates were 35.8% and 30.0% in patients with and without VAP, respectively (P = 0.30). In the whole cohort, VAP (adjusted HR 3.16, 95% CI 2.04–4.89, P < 0.0001), the SAPS-2 value at admission, chronic renal disease and an admission for cardiac arrest predicted death at day 90, while the COVID-19 status had no independent impact. When analysed separately, VAP predicted death in non-COVID-19 patients (aHR 3.43, 95% CI 2.11–5.58, P < 0.0001) but not in those with COVID-19 (aHR 1.19, 95% CI 0.32–4.49, P = 0.80). Conclusions VAP is an independent predictor of 90-day mortality in ARDS patients. This condition exerts a limited impact on oxygenation but correlates with extended MV duration, vasoactive support, and LOS.https://doi.org/10.1186/s13613-022-00998-7Acute respiratory distress syndromeVentilator-associated pneumoniaIntensive care unitMechanical ventilationHospital-acquired infectionCOVID-19 |
| spellingShingle | Marc Le Pape Céline Besnard Camelia Acatrinei Jérôme Guinard Maxime Boutrot Claire Genève Thierry Boulain François Barbier Clinical impact of ventilator-associated pneumonia in patients with the acute respiratory distress syndrome: a retrospective cohort study Annals of Intensive Care Acute respiratory distress syndrome Ventilator-associated pneumonia Intensive care unit Mechanical ventilation Hospital-acquired infection COVID-19 |
| title | Clinical impact of ventilator-associated pneumonia in patients with the acute respiratory distress syndrome: a retrospective cohort study |
| title_full | Clinical impact of ventilator-associated pneumonia in patients with the acute respiratory distress syndrome: a retrospective cohort study |
| title_fullStr | Clinical impact of ventilator-associated pneumonia in patients with the acute respiratory distress syndrome: a retrospective cohort study |
| title_full_unstemmed | Clinical impact of ventilator-associated pneumonia in patients with the acute respiratory distress syndrome: a retrospective cohort study |
| title_short | Clinical impact of ventilator-associated pneumonia in patients with the acute respiratory distress syndrome: a retrospective cohort study |
| title_sort | clinical impact of ventilator associated pneumonia in patients with the acute respiratory distress syndrome a retrospective cohort study |
| topic | Acute respiratory distress syndrome Ventilator-associated pneumonia Intensive care unit Mechanical ventilation Hospital-acquired infection COVID-19 |
| url | https://doi.org/10.1186/s13613-022-00998-7 |
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