• Fernando G Zampieri, Pedro Póvoa, Jorge I Salluh, Alejandro Rodriguez, Sandrine Valade, Andrade Gomes José J Unidade de Cuidados Intensivos, Hospital da Luz Lisboa, Lisboa, Portugal., Jean Reignier, Elena Molinos, Jordi Almirall, Nicolas Boussekey, Lorenzo Socias, Paula Ramirez, William N Viana, Anahita Rouzé, Saad Nseir, and Ignacio Martin-Loeches.
• HC or Research Institute, Hospital do Coração, São Paulo, Brazil.
• J Intensive Care Med. 2020 Jun 1; 35 (6): 588-594.

ObjectiveTo assess whether ventilator-associated lower respiratory tract infections (VA-LRTIs) are associated with mortality in critically ill patients with acute respiratory distress syndrome (ARDS).Materials And MethodsPost hoc analysis of prospective cohort study including mechanically ventilated patients from a multicenter prospective observational study (TAVeM study); VA-LRTI was defined as either ventilator-associated tracheobronchitis (VAT) or ventilator-associated pneumonia (VAP) based on clinical criteria and microbiological confirmation. Association between intensive care unit (ICU) mortality in patients having ARDS with and without VA-LRTI was assessed through logistic regression controlling for relevant confounders. Association between VA-LRTI and duration of mechanical ventilation and ICU stay was assessed through competing risk analysis. Contribution of VA-LRTI to a mortality model over time was assessed through sequential random forest models.ResultsThe cohort included 2960 patients of which 524 fulfilled criteria for ARDS; 21% had VA-LRTI (VAT = 10.3% and VAP = 10.7%). After controlling for illness severity and baseline health status, we could not find an association between VA-LRTI and ICU mortality (odds ratio: 1.07; 95% confidence interval: 0.62-1.83; P = .796); VA-LRTI was also not associated with prolonged ICU length of stay or duration of mechanical ventilation. The relative contribution of VA-LRTI to the random forest mortality model remained constant during time. The attributable VA-LRTI mortality for ARDS was higher than the attributable mortality for VA-LRTI alone.ConclusionAfter controlling for relevant confounders, we could not find an association between occurrence of VA-LRTI and ICU mortality in patients with ARDS.

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