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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