HC or Research Institute, Hospital do Coração, São Paulo, Brazil.
Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
J Intensive Care Med. 2020 Jun;35(6):588-594. doi: 10.1177/0885066618772498. Epub 2018 Apr 26.
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).
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.
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.
After controlling for relevant confounders, we could not find an association between occurrence of VA-LRTI and ICU mortality in patients with ARDS.
评估呼吸机相关性下呼吸道感染（VA-LRTIs）与急性呼吸窘迫综合征（ARDS）患者的死亡率是否相关。
对一项多中心前瞻性观察研究（TAVeM 研究）中的机械通气患者进行回顾性队列研究的事后分析；根据临床标准和微生物学确认，将 VA-LRTI 定义为呼吸机相关性气管支气管炎（VAT）或呼吸机相关性肺炎（VAP）。通过逻辑回归控制相关混杂因素，评估 ARDS 患者和无 VA-LRTI 患者 ICU 死亡率之间的关联。通过竞争风险分析评估 VA-LRTI 与机械通气时间和 ICU 住院时间之间的关联。通过序贯随机森林模型评估 VA-LRTI 对随时间变化的死亡率模型的贡献。
该队列纳入了 2960 名患者，其中 524 名符合 ARDS 标准；21%的患者发生了 VA-LRTI（VAT = 10.3%，VAP = 10.7%）。在控制疾病严重程度和基线健康状况后，我们无法发现 VA-LRTI 与 ICU 死亡率之间存在关联（比值比：1.07；95%置信区间：0.62-1.83；P =.796）；VA-LRTI 也与 ICU 住院时间延长或机械通气时间无关。VA-LRTI 对随机森林死亡率模型的相对贡献在整个时间内保持不变。ARDS 的归因 VA-LRTI 死亡率高于 VA-LRTI 单独的归因死亡率。
在控制相关混杂因素后，我们无法发现 ARDS 患者中 VA-LRTI 的发生与 ICU 死亡率之间存在关联。
