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Article Dans Une Revue Journal of Intensive Care Medicine Année : 2020

Lower Respiratory Tract Infection and Short-Term Outcome in Patients With Acute Respiratory Distress Syndrome.

G Zampieri Fernando
  • Fonction : Auteur
Pedro Povoa
  • Fonction : Auteur
I Salluh Jorge
  • Fonction : Auteur
Alejandro Rodriguez
  • Fonction : Auteur
Jose Andrade Gomes
  • Fonction : Auteur
Jean Reignier
  • Fonction : Auteur
Elena Molinos
  • Fonction : Auteur
Jordi Almirall
  • Fonction : Auteur
Nicolas Boussekey
  • Fonction : Auteur
Lorenzo Socias
  • Fonction : Auteur
Paula Ramirez
  • Fonction : Auteur
N Viana William
  • Fonction : Auteur
Ignacio Martin-Loeches
  • Fonction : Auteur

Résumé

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.
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hal-04321767 , version 1 (22-12-2023)

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G Zampieri Fernando, Pedro Povoa, I Salluh Jorge, Alejandro Rodriguez, Sandrine Valade, et al.. Lower Respiratory Tract Infection and Short-Term Outcome in Patients With Acute Respiratory Distress Syndrome.. Journal of Intensive Care Medicine, 2020, Journal of Intensive Care Medicine, 35, pp.588-594. ⟨10.1177/0885066618772498⟩. ⟨hal-04321767⟩

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