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

Critical Care, 04/24/2012

Forel JM et al. – In patients with severe acute respiratory distress syndrome (ARDS) receiving lung–protective ventilation, ventilator–associated pneumonia (VAP) was associated with an increased crude ICU mortality which did not remain significant after adjustment.


  • This prospective epidemiological study was done in all patients included in 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.


  • Ninety-eight patients (28.9%) presented at least one episode of microbiologically documented bacterial VAP, including 41 (41.8%) who died in the ICU, compared to 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 2days 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.

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