title: Early-onset pneumonia after cardiac arrest: characteristics, risk factors and influence on prognosis.
abstract: BACKGROUND
  Although frequent, little is known about early-onset pneumonia that occurs in the postresuscitation period. Although induced hypothermia is recommended as a method of improving neurological outcome, its influence on the occurrence of early-onset pneumonia is not well defined.
  
  
  OBJECTIVE
  To describe the incidence, risk factors, causative agents, and impact on outcome of early-onset pneumonia occurring within 3 days after out-of-hospital cardiac arrest (OHCA).
  
  
  METHODS
  Retrospective analysis of a large cohort study of all patients successfully resuscitated after OHCA and admitted from July 2002 to March 2008 in two medical intensive care units (ICUs). Patients who presented accidental hypothermia or a known pneumonia before OHCA, or patients who died within the first 24 hours, were excluded.
  
  
  RESULTS
  During this 6-year period, 845 patients were admitted after OHCA, and 641 consecutive patients were included. A total of 500 patients (78%) were treated with therapeutic hypothermia. In the first 3 days, 419 (65%) presented early-onset pneumonia. Multivariate analysis disclosed therapeutic hypothermia as the single independent risk factor of early-onset pneumonia (odds ratio, 1.90; 95% confidence interval, 1.28-2.80; P = 0.001). Early-onset pneumonia increased length of mechanical ventilation (5.7 ± 5.9 vs. 4.7 ± 6.2 d; P = 0.001) and ICU stay (7.9 ± 7.2 versus 6.7 ± 7.6 d; P = 0.001), but did not influence incidence of ventilator-associated pneumonia (P = 0.25), favorable neurologic outcome (P = 0.35), or ICU mortality (P = 0.26).
  
  
  CONCLUSIONS
  After OHCA, therapeutic hypothermia is associated with an increased risk of early-onset pneumonia. This complication was associated with prolonged respiratory support and ICU stay, but did not significantly influence ICU mortality.
authors.affiliation: Medical Intensive Care Unit, Cochin Hospital, Paris, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Perbet
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mongardon
authors.forename: Florence
authors.initials: F
authors.lastname: Dumas
authors.forename: Cédric
authors.initials: C
authors.lastname: Bruel
authors.forename: Virginie
authors.initials: V
authors.lastname: Lemiale
authors.forename: Bruno
authors.initials: B
authors.lastname: Mourvillier
authors.forename: Pierre
authors.initials: P
authors.lastname: Carli
authors.forename: Olivier
authors.initials: O
authors.lastname: Varenne
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
mesh_terms: D000368:Aged; D005260:Female; D005602:France; D006323:Heart Arrest / Q000628:therapy*; D006784:Hospitals, Teaching; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects*; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011014:Pneumonia / Q000209:etiology*; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors