Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy. - Archive ouverte HAL Access content directly
Journal Articles Critical Care Year : 2012

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

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Arnaud Gacouin
  • Function : Author
  • PersonId : 925095
Gilles Perrin
  • Function : Author
  • PersonId : 925096
Karine Barrau
  • Function : Author
  • PersonId : 925097
Samir Jaber
Jean-Michel Arnal
  • Function : Author
  • PersonId : 925098
Mohamed Fathallah
  • Function : Author
  • PersonId : 925099
Pascal Auquier
  • Function : Author
  • PersonId : 860193
Elie Azoulay
  • Function : Author
  • PersonId : 866311

Abstract

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 using a strictly standardized lung-protective strategy. METHODS: 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. RESULTS: 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 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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inserm-00697185 , version 1 (14-05-2012)

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Jean-Marie Forel, François Voillet, Daniel Pulina, Arnaud Gacouin, Gilles Perrin, et al.. Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy.. Critical Care, 2012, 16 (2), pp.R65. ⟨10.1186/cc11312⟩. ⟨inserm-00697185⟩
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