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

2019; Springer Science+Business Media; Volume: 45; Issue: 12 Linguagem: Inglês

10.1007/s00134-019-05797-6

1432-1238

Ignacio Martín‐Loeches, Antoní Torres, Pedro Póvoa, Fernando G. Zampieri, Jorge I. Salluh, Saad Nseir, Miquel Ferrer, Alejandro Rodríguez, Ignacio Martín‐Loeches, Pedro Póvoa, Fernando G. Zampieri, Jorge I. Salluh, Saad Nseir, Alejandro Rodríguez, Daniel Curcio, Jean-Paul Mira, María Laura Cordero, Raphaël Lepecq, Christophe Girault, C. Candeias, Philippe Séguin, Christian Ovalle, Jonathan Messika, A. González-Castro, Luís Coelho, L. Rabello, Thiago Lisboa, Antoní Torres, Jorge I. Salluh, Saad Nseir, Rubén Fernández, J. Arroyo, Máryori Gabriela, Regino Rodríguez, Adalgiza Reyes, Christian Dellera, Francisco Molina, Daniel Franco, Eduardo García Parada, Estuardo Salgado Yepez, F. Paredes Oña, Diego Morocho Tutillo, D. Barahona, Francisco Álvarez-Lerma, Antonio Álvarez, Juan Gallego, Francisco Jiménez Morillas, Alvaro Aguilar, M. L. Lorenzana, Rafael Sánchez Iniesta, Jordi Almirall, Antonio Albaya, S. Ruiz Santana, C. Rodríguez Fernández, M. A. Potro, P. V. Cortes, Beatriz Jiménez, Rafael Sierra, Marta Ortíz, N. Cruza, Pedro Olaechea, Ana Carolina Caballero Zirena, Paloma Gonzalez, Tahiry Gómez, Lorenzo Socías Crespí, Paula Ramírez, R. Jordà Marcos, C. Palazón, B Rueda, Juan Ballesteros, M.P. Gracia Arnilla, Antònia Socías, Jovanhy Castillo Amador, Esperanza Molero Silvero, L. Macaya Redin, M. Elson, Lluís Cabré Pericas, Judit Rodríguez, María Nieto, Antoní Torres, Elena Molinos, A. Josefi, Nuno Catorze, Pedro Póvoa, C. Candeias, Luís Coelho, Paulo André, Miguel Ángel, Gema García-Sáez, C. Sánchez Ramírez, M. Calizaya, Ángel Estella, Albis Cecilia Hani A, Gerardo Aguilar, Eva Torrents, Melany Puente, A. G. Sanchez, Thiago Lisboa, Pedro Azambuja, Marcos Freitas Knibel, Otávio T. Ranzani, L. D. Camargo, Artur P. Águas, Catarina B. Ferreira, Suzana Margareth Lobo, L. Rabello, Man Sik Park, Altamiro Gabriel de Oliveira Carvalho, M. Valencia, A. González-Castro, Alberto Arias López, Javier Martínez Caballero, Saad Nseir, Karim Jaffal, Erika Parmentier-Decrucq, Sébastien Preau, C. Rousselin, Caroline Blazejewski, Juliette Masse, Laurent Robriquet, Léa Satre-Buisson, Jean-Paul Mira, N. Martin, Raphaël Lepecq, Hervé Mentec, Christophe Girault, Antoine Marchalot, Jonathan Messika, Jean-Damien Ricard, Philippe Séguin, Bruno Mégarbane, Sandrine Valade, Élie Azoulay, Nicolas Boussekey, O. Leroy, Jean Reignier, M. Clavel, Nicolas Pichon, Thomas Baudry, Laurent Argaud, Pascal Beuret, Ali Ait Hssain, Martine Nyunga, I. Alves, Florent Dewavrin, Guillaume Brunin, S. Mérat, Pierre Pasquier, F Brun, Aurore Palud, B. Voisin, Romaric Grenot, Nicolas Van Grunderbeeck, Didier Thévenin, Benoît Misset, François Philippart, J. P. Frat, Rémi Coudroy, P. Cabaret, M. Ledein, F. Z. Slimane, Romain Miguel-Montanes, Nicolas Weiss, Françis Bolgert, B. Just,

Sepsis Diagnosis and Treatment

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. 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. 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. 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. ClinicalTrials.gov, number NCT01791530.