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Intensive Care Medicine

, Volume 45, Issue 12, pp 1753–1762 | Cite as

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

  • Ignacio Martin-LoechesEmail author
  • Antoni Torres
  • Pedro Povoa
  • Fernando G. Zampieri
  • Jorge Salluh
  • Saad Nseir
  • Miquel Ferrer
  • Alejandro Rodriguez
  • TAVeM study Group
Original

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Trial registry

ClinicalTrials.gov, number NCT01791530.

Keywords

Pneumonia VAP SEPSIS VAT VA-LRTI Antibiotic stewardship 

Notes

Acknowledgements

TAVeM study Group

Writing committee: Ignacio Martín-Loeches, Pedro Povoa, Fernando Zampieri, Jorge Salluh, Saad Nseir and Alejandro Rodriguez.

Participants: I Martin-Loeches, P Povoa, A Rodríguez, D Curcio, J. P. Mira, M. L. Cordero, R. Lepecq, C. Girault, C. Candeias, P. Seguin, C. Paulino, J. Messika, A. G. Castro, L. Coelho, L. Rabello, T. Lisboa, A. Torres, J. Salluh, S. Nseir, R. O. Fernández, J. Arroyo, M. Gabriela, R. Alvarez, A. T. Reyes, C. Dellera, F. Molina, D. M. Franco, E. G. Parada, E. S. Yepez, F. P. Oña, D. M. Tutillo, D. Barahona, F. A. Lerma, A.A. Álvarez, J. M. Gallego, F. J. Morillas, A. L. Aguilar, M. L. Lorenzana, R. S. Iniesta, J. Almirall, A. Albaya, S. R. Santana, C. Fernandez, M. A. Potro, P. V. Cortes, B. Jimenez, R. Sierra, M. Del Valle Ortiz, N. Cruza, P. M. Olaechea, A. C. Zirena, P. P. Gonzalez, T. R. Gomez, L. S. Crespi, P.R. Galleymore, R. J. Marcos, C. Palazón, B. G. Rueda, J. C. Ballesteros, M. P. Arnilla, A. Socias, J. Amador, E. M. Silvero, L. M. Redín, M. Z. Elson, L. C. Pericas, J. Á. Rodríguez, M. Nieto, A. Torres, E. Molinos, A. Josefi, N. Catorze, P. Póvoa, C. Candeias, L. Coelho, P. André, M. Ángel, G. García, C. S. Ramirez, M. Calizaya, A. Estella, A. Albis, G. Aguilar, E. Torrents, M. G. Puente, A. G. Sanchez, T. Lisboa, P. Azambuja, M. F. Knibel, O. Ranzani, L. D. Camargo, A. P. Junior, C. B. Ferreira, S. Lobo, L. Rabello, M. Park, A. G. de Carvalho, M. Valencia, A. G. Castro, A. A. López, J. M. Caballero, S. Nseir, K. Jaffal, E. Parmentier-Decrucq, S. Préau, C. Rousselin, C. Blazejewski, J. Masse, L. Robriquet, L. Satre-Buisson, J. P. Mira, N. Martin, R. Lepecq, H. Mentec, C. Girault, A. Marchalot, J. Messika, J. D. Ricard, P. Seguin, B. Mégarbane, S. Valade, E. Azoulay, N. Boussekey, O. Leroy, J. Reignier, M. Clavel, N. Pichon, T. Baudry, L. Argaud, P. Beuret, A. A. Hssain, M. Nyunga, I. Alves, F. Dewavrin, G. Brunin, S. Mérat, P. Pasquier, F. Brun, A. Palud, B. Voisin, R. Grenot, N. Van Grunderbeeck, D. Thévenin, B. Misset, F. Philippart, J. P. Frat, R. Coudroy, P. Cabaret, M. Ledein, F. Z. Slimane, R. Miguel-Montanes, N. Weiss, F. Bolgert, B. Just.

Funding

Funding was supported by Joint Programming Initiative on Antimicrobial Resistance (Grant number 2018-06335). Grant support: 7th JPIAMR Call for Networks reg. no. 2018-06335

Compliance with ethical standards

Conflicts of interest

All author declares that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ignacio Martin-Loeches
    • 1
    • 2
    • 3
    Email author
  • Antoni Torres
    • 3
  • Pedro Povoa
    • 4
    • 5
    • 6
  • Fernando G. Zampieri
    • 7
  • Jorge Salluh
    • 8
  • Saad Nseir
    • 9
  • Miquel Ferrer
    • 3
  • Alejandro Rodriguez
    • 10
  • TAVeM study Group
  1. 1.Department of Anaesthesia and Critical Care MedicineSt. James’s HospitalDublinIreland
  2. 2.Multidisciplinary Intensive Care Research Organization (MICRO), St James’s HospitalDublin 8Ireland
  3. 3.Pulmonary Intensive Care UnitRespiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, University of BarcelonaBarcelonaSpain
  4. 4.Polyvalent Intensive Care UnitSão Francisco Xavier Hospital, Centro Hospitalar de Lisboa OcidentalLisbonPortugal
  5. 5.NOVA Medical SchoolNew University of LisbonLisbonPortugal
  6. 6.Center for Clinical Epidemiology and Research Unit of Clinical EpidemiologyOUH Odense University HospitalOdenseDenmark
  7. 7.HCor Research Institute, Hospital do CoraçãoSão PauloBrazil
  8. 8.Department of Critical Care and Graduate Program in Translational MedicineD’Or Institute for Research and EducationRio De JaneiroBrazil
  9. 9.Critical Care Center, University Hospital of LilleLille UniversityLilleFrance
  10. 10.Critical Care DepartmentHospital Universitario Joan XXIII, URV/IISPV/CIBERESTarragonaSpain

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