title: Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) may contribute to the mortality associated with acute respiratory distress syndrome (ARDS). We aimed to determine the incidence, outcome, and risk factors of bacterial VAP complicating severe ARDS in patients ventilated by using a strictly standardized lung-protective strategy.
  
  
  METHODS
  This prospective epidemiologic study was done in all the 339 patients with severe ARDS included in a multicenter randomized, placebo-controlled double-blind trial of cisatracurium besylate in severe ARDS patients. Patients with suspected VAP underwent bronchoalveolar lavage to confirm the diagnosis.
  
  
  RESULTS
  Ninety-eight (28.9%) patients had at least one episode of microbiologically documented bacterial VAP, including 41 (41.8%) who died in the ICU, compared with 74 (30.7%) of the 241 patients without VAP (P = 0.05). After adjustment, age and severity at baseline, but not VAP, were associated with ICU death. Cisatracurium besylate therapy within 2 days of ARDS onset decreased the risk of ICU death. Factors independently associated with an increased risk to develop a VAP were male sex and worse admission Glasgow Coma Scale score. Tracheostomy, enteral nutrition, and the use of a subglottic secretion-drainage device were protective.
  
  
  CONCLUSIONS
  In patients with severe ARDS receiving lung-protective ventilation, VAP was associated with an increased crude ICU mortality which did not remain significant after adjustment.
authors.affiliation: Service de Réanimation des Détresses Respiratoires et Infections Sévères, Assistance Publique Hôpitaux de Marseille, URMITE CNRS-UMR 6236, Aix-Marseille Univ, Marseille 13015, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Forel
authors.forename: François
authors.initials: F
authors.lastname: Voillet
authors.forename: Daniel
authors.initials: D
authors.lastname: Pulina
authors.forename: Arnaud
authors.initials: A
authors.lastname: Gacouin
authors.forename: Gilles
authors.initials: G
authors.lastname: Perrin
authors.forename: Karine
authors.initials: K
authors.lastname: Barrau
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Arnal
authors.forename: Mohamed
authors.initials: M
authors.lastname: Fathallah
authors.forename: Pascal
authors.initials: P
authors.lastname: Auquier
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
mesh_terms: D016009:Chi-Square Distribution; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality*; D004311:Double-Blind Method; D005260:Female; D005602:France / Q000453:epidemiology; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010919:Placebos; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000401:mortality*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000401:mortality*; D012128:Respiratory Distress Syndrome / Q000382:microbiology / Q000401:mortality*; D012307:Risk Factors; D018709:Statistics, Nonparametric
chemical_list: D010919:Placebos