Multicenter prospective study of ventilator-associated pneumonia during acute respiratory distress syndrome - Incidence, prognosis, and risk factors

We investigated the incidence, risk factors for, and outcome of ventilator- associated pneumonia (VAP) in patients with acute respiratory distress synd rome (ARDS). We compared 134 patients with ARDS with 744 patients without A RDS on mechanical ventilation. Fiberoptic bronchoscopic examination and qua ntitative bacterial cultures (protected brush or catheter sampling [thresho ld: 10(3) cfu/ml], or bronchoalveolar ravage [threshold: 10(4) cfu/ml]) wer e used to diagnose pneumonia. VAP occurred in 49 patients (36.5%). The inci dence of pneumonia was 23% (173 of 744 patients) among patients without ARD S (p < 0.002). Nonfermenting gram-negative rods caused significantly more p neumonia in ARDS patients. Mortality rates were identical in ARDS patients with (28 of 49 patients, 57%) and without (50 of 85 patients, 59%) pulmonar y infection (p = 0.8). VAP resulted in a considerable increase in attributa ble time on mechanical ventilation of both the overall population of ARDS p atients and of survivors. Both the use of sucralfate (adjusted odds ratio [ OR]: 4.42; 95% confidence interval [CI]: 2.01 to 9.7, p = 0.0002) and the d uration of exposure to sucralfate (adjusted OR: 1.206; 95% CI: 1.095 to 1.3 28, p = 0.0002) were associated with an increased risk of VAP during ARDS. VAP considerably prolongs the time on mechanical ventilation without affect ing survival. Patients given sucralfate may be at greater risk of developin g pulmonary infection during ARDS.