For a study, researchers sought to observe whether the patients who met the Berlin criteria for ARDS and were admitted over 18 months in 2 intensive care units (ICU) at a university-affiliated hospital were retrospectively included. A Cox proportional hazards model with VAP as a delay entry variable was used to assess the relationship between VAP and the chance of mortality at day 90 (primary endpoint). Secondary endpoints in patients with and without VAP included potential changes in the PaO2/FiO2 ratio and SOFA score values around VAP (linear mixed modeling), mechanical ventilation (MV) duration, numbers of ventilator- and vasopressor-free days at day 28, and length of stay (LOS) in patients with and without VAP (median or absolute risk difference calculation). Patients with COVID-19-related ARDS and those with ARDS from other causes were divided into subgroups. About 176 (52.4%) of the 336 patients included in the study (101 with COVID-19 and 235 with other ARDS) had their first VAP. VAP caused a brief and modest decrease in the PaO2/FiO2 ratio without increasing SOFA score values. At day 28, VAP was linked to fewer ventilator-free days (median difference and 95% CI, -19 [-20;-13.5] days) and vasopressor-free days (-5 [-9;-2] days), as well as longer ICU (+13 [+ 9;+15] days) and hospital (+11.5 [+7.5;+17.5] days) LOS. Both categories experienced these effects. The overall day-90 death rates in patients with and without VAP were 35.8% and 30.0%, respectively (P=0.30). VAP (adjusted HR 3.16, 95% CI 2.04–4.89, P<0.0001), the SAPS-2 score at admission, chronic renal illness, and a cardiac arrest hospitalization all predicted death at day 90 in the entire group, while COVID-19 status had no independent influence. VAP predicted death in non-COVID-19 patients (aHR 3.43,95% CI 2.11–5.58, P<0.0001) but not in COVID-19 patients (aHR 1.19,95% CI 0.32–4.49, P=0.80) when analysed individually. In ARDS patients, VAP was an independent predictor of 90-day mortality. Although this syndrome had a minor impact on oxygenation, it was linked to longer MV length, vasoactive support, and LOS.
Source:annalsofintensivecare.springeropen.com/articles/10.1186/s13613-022-00998-7
