Epidemiology, risk factors and prognosis of ventilator-associated pneumonia during severe COVID-19: Multicenter observational study across 149 European Intensive Care Units - 18/01/23
, Jean-Michel Constantin b, Nicholas Heming c, d, e, Laurent Camous f, Alexis Ferré g, Keyvan Razazi h, i, Nathanaël Lapidus jon behalf of the COVID-ICU Investigators1
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Abstract |
Background |
COVID-19 patients requiring mechanical ventilation are particularly at risk of developing ventilator-associated pneumonia (VAP). Risk factors and the prognostic impact of developing VAP during critical COVID-19 have not been fully documented.
Methods |
Patients invasively ventilated for at least 48 h from the prospective multicentre COVID-ICU database were included in the analyses. Cause-specific Cox regression models were used to determine factors associated with the occurrence of VAP. Cox-regression multivariable models were used to determine VAP prognosis. Risk factors and the prognostic impact of early vs. late VAP, and Pseudomonas-related vs. non-Pseudomonas-related VAP were also determined.
Main findings |
3388 patients were analysed (63 [55–70] years, 75.8% males). VAP occurred in 1523/3388 (45.5%) patients after 7 [5–9] days of ventilation. Identified bacteria were mainly Enterobacteriaceae followed by Staphylococcus aureus and Pseudomonas aeruginosa. VAP risk factors were male gender (Hazard Ratio (HR) 1.26, 95% Confidence Interval [1.09–1.46]), concomitant bacterial pneumonia at ICU admission (HR 1.36 [1.10–1.67]), PaO2/FiO2 ratio at intubation (HR 0.99 [0.98–0.99] per 10 mmHg increase), neuromuscular-blocking agents (HR 0.89 [0.76–0.998]), and corticosteroids (HR 1.27 [1.09–1.47]). VAP was associated with 90-mortality (HR 1.34 [1.16–1.55]), predominantly due to late VAP (HR 1.51 [1.26–1.81]). The impact of Pseudomonas-related and non-Pseudomonas-related VAP on mortality was similar.
Conclusion |
VAP affected almost half of mechanically ventilated COVID-19 patients. Several risk factors have been identified, among which modifiable risk factors deserve further investigation. VAP had a specific negative impact on 90-day mortality, particularly when it occurred between the end of the first week and the third week of ventilation.
Le texte complet de cet article est disponible en PDF.Keywords : COVID-19, Intensive Care Unit, Invasive mechanical ventilation, Mortality, Risk factors, Ventilator-associated pneumonia
Abbreviations : ARDS, C-VAP, COVID-19, HR, ICU, IL, IMV, NC-VAP, NMBA, VAP
Plan
Vol 42 - N° 1
Article 101184- février 2023 Retour au numéro
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