The association of cardiovascular failure with treatment for ventilator-associated lower respiratory tract infection

[en] Purpose: Ventilator associated-lower respiratory tract infections (VA-LRTIs), either ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), accounts for most nosocomial infections in intensive care units (ICU) including. Our aim was to determine if appropriate antibiotic treatment in patients with VA-LRTI will effectively reduce mortality in patients who had cardiovascular failure. Methods: This was a pre-planned subanalysis of a large prospective cohort of mechanically ventilated patients for at least 48 h in eight countries in two continents. Patients with a modified Sequential Organ Failure Assessment (mSOFA) cardiovascular score of 4 (at the time of VA-LRTI diagnosis and needed be present for at least 12 h) were defined as having cardiovascular failure. Results: VA-LRTI occurred in 689 (23.2%) out of 2960 patients and 174 (25.3%) developed cardiovascular failure. Patients with cardiovascular failure had significantly higher ICU mortality than those without (58% vs. 26.8%; p < 0.001; OR 3.7; 95% CI 2.6–5.4). A propensity score analysis found that the presence of inappropriate antibiotic treatment was an independent risk factor for ICU mortality in patients without cardiovascular failure, but not in those with cardiovascular failure. When the propensity score analysis was conducted in patients with VA-LRTI, the use of appropriate antibiotic treatment conferred a survival benefit for patients without cardiovascular failure who had only VAP. Conclusions: Patients with VA-LRTI and cardiovascular failure did not show an association to a higher ICU survival with appropriate antibiotic treatment. Additionally, we found that in patients without cardiovascular failure, appropriate antibiotic treatment conferred a survival benefit for patients only with VAP. Trial registry: ClinicalTrials.gov, number NCT01791530. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

Disciplines :

Anesthesia & intensive care

Author, co-author :

Martin-Loeches, I.; Department of Anaesthesia and Critical Care Medicine, St. James’s Hospital, Dublin, Ireland, Multidisciplinary Intensive Care Research Organization (MICRO), St James’s Hospital, P.O. Box 580, James’s Street, Dublin 8, Ireland, Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, CIBERes, Barcelona, Spain

Torres, A.; Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, CIBERes, Barcelona, Spain

Povoa, P.; Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal, NOVA Medical School, New University of Lisbon, Lisbon, Portugal, Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark

Zampieri, F. G.; HCor Research Institute, Hospital do Coração, São Paulo, Brazil

Salluh, J.; Department of Critical Care and Graduate Program in Translational Medicine, D’Or Institute for Research and Education, Rio De Janeiro, Brazil

Nseir, S.; Critical Care Center, University Hospital of Lille, Lille University, Lille, France

Ferrer, M.; Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, CIBERes, Barcelona, Spain

Rodriguez, A.; Critical Care Department, Hospital Universitario Joan XXIII, URV/IISPV/CIBERES, Tarragona, Spain

Martin-Loeches, I.

Povoa, P.

More authors (154 more)

Language :

English

Title :

The association of cardiovascular failure with treatment for ventilator-associated lower respiratory tract infection

Publication date :

2019

Journal title :

Intensive Care Medicine

ISSN :

0342-4642

eISSN :

1432-1238

Publisher :

Springer

Volume :

Issue :

Pages :

1753-1762

Peer reviewed :

Peer Reviewed verified by ORBi

Funders :

Joint Programming Initiative on Antimicrobial Resistance, JPIAMR: 2018-06335

Available on ORBi :

since 10 December 2019

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