We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Lower Respiratory Tract Infection and Short-Term Outcome in Patients With Acute Respiratory Distress Syndrome.
- Authors
Zampieri, Fernando G.; Póvoa, Pedro; Salluh, Jorge I.; Rodriguez, Alejandro; Valade, Sandrine; Andrade Gomes, José; Reignier, Jean; Molinos, Elena; Almirall, Jordi; Boussekey, Nicolas; Socias, Lorenzo; Ramirez, Paula; Viana, William N.; Rouzé, Anahita; Nseir, Saad; Martin-Loeches, Ignacio
- 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.
- Subjects
MORTALITY risk factors; BRONCHITIS; CONFIDENCE intervals; CRITICALLY ill; HEALTH status indicators; LENGTH of stay in hospitals; INTENSIVE care units; LONGITUDINAL method; SCIENTIFIC observation; PATIENTS; PNEUMONIA; ADULT respiratory distress syndrome; RESPIRATORY infections; RISK assessment; STATISTICS; TRACHEAL diseases; LOGISTIC regression analysis; DATA analysis; SEVERITY of illness index; TREATMENT duration; RANDOM forest algorithms; ODDS ratio; VENTILATOR-associated pneumonia; DISEASE complications
- Publication
Journal of Intensive Care Medicine, 2020, Vol 35, Issue 6, p588
- ISSN
0885-0666
- Publication type
Article
- DOI
10.1177/0885066618772498