Acta Anaesthesiol Scand. 2022 Mar 26. doi: 10.1111/aas.14063. Online ahead of print.
ABSTRACT
BACKGROUND: We aimed at investigating the incidence, characteristics and outcome of ventilator-associated pneumonia (VAP) in patients after cardiac arrest (CA) and its potential association with mild therapeutic hypothermia (MTH). We hypothesised, that MTH might increase the risk of VAP.
METHODS: Prospective observational study including comatose adult patients after successful resuscitation from out-of-hospital or in-hospital CA with presumed cardiac cause admitted to ICU and treated with MTH at 33°C for 24h or normothermia (NT) with treatment of fever ≥ 38°C by pharmacological means. The primary outcome measure was the development of VAP. VAP diagnosis included mechanical ventilation >48h combined with clinical and radiologic criteria. For a microbiologically confirmed VAP (mcVAP) a positive respiratory culture was required.
RESULTS: 23% of 171 patients developed VAP, 6% presented with mcVAP. VAP was associated with increased ICU-LOS (9 (IQR 5-14) vs. 6 (IQR 3-9) days; p<0.01), ventilator-dependent days (6 (IQR 4-9) vs. 4 (IQR 2-7) days; p<0.01) and duration of antibiotic treatment (9 (IQR 5-13) vs. 5 (IQR 2-9) days; p<0.01), but not with mortality (OR 0.88 (95% CI: 0.43-1.81); p=0.74). Patients treated with MTH (47%) presented higher VAP (30 vs. 17%; p=0.04) and mcVAP rates (11 vs. 2%; p=0.03). MTH was associated with VAP in multivariable logistic regression analysis with an OR of 2.67 (95% CI: 1.22-5.86); p=0.01.
CONCLUSIONS: VAP appears to be a common complication in patients after CA, accompanied by more ventilator-dependent days, prolonged antibiotic treatment and ICU-LOS. Treatment with MTH is significantly associated with development of VAP.
PMID:35338658 | DOI:10.1111/aas.14063
