• Chest · Jul 2014

    Randomized Controlled Trial Multicenter Study

    Ventilator-associated pneumonia during weaning from mechanical ventilation: role of fluid management.

    • Armand Mekontso Dessap, Sandrine Katsahian, Ferran Roche-Campo, Hugo Varet, Achille Kouatchet, Vinko Tomicic, Gaetan Beduneau, Romain Sonneville, Samir Jaber, Michael Darmon, Diego Castanares-Zapatero, Laurent Brochard, and Christian Brun-Buisson.
    • Service de Réanimation Médicale, AP-HP, CHU Henri Mondor, Créteil, F-94010, France; Faculté de Médecine, Université Paris Est Créteil, Créteil, F-94010, France; INSERM, Unité U955, Créteil, F-94010, France. Electronic address: armand.dessap@hmn.aphp.fr.
    • Chest. 2014 Jul 1; 146 (1): 58-65.

    BackgroundPulmonary edema may alter alveolar bacterial clearance and infectivity. Manipulation of fluid balance aimed at reducing fluid overload may, therefore, influence ventilator-associated pneumonia (VAP) occurrence in intubated patients. The objective of the present study was to assess the impact of a depletive fluid-management strategy on ventilator-associated complication (VAC) and VAP occurrence during weaning from mechanical ventilation.MethodsWe used data from the B-type Natriuretic Peptide for the Fluid Management of Weaning (BMW) randomized controlled trial performed in nine ICUs across Europe and America. We compared the cumulative incidence of VAC and VAP between the biomarker-driven, depletive fluid-management group and the usual-care group during the 14 days following randomization, using specific competing-risk methods (the Fine and Gray model).ResultsAmong the 304 patients analyzed, 41 experienced VAP, including 27 (17.8%) in the usual-care group vs 14 (9.2%) in the interventional group (P = .03). From the Fine and Gray model, the probabilities of VAC and VAP occurrence were both significantly reduced with the interventional strategy while adjusting for weaning outcome as a competing event (subhazard ratios [25th-75th percentiles], 0.44 [0.22-0.87], P = .02 and 0.50 [0.25-0.96], P = .03, respectively).ConclusionsUsing proper competing risk analyses, we found that a depletive fluid-management strategy, when initiating the weaning process, has the potential for lowering VAP risk in patients who are mechanically ventilated.Trial RegistryClinicalTrials.gov; No.: NCT00473148; URL: www.clinicaltrials.gov.

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