The median duration of mechanical ventilation was longer in patients with VAP who were alive on day 90. As shown in Figure Figure4,4, patients without VAP were disconnected earlier from the ventilator.Figure 4Probability of breathing without assistance from the day of inclusion to day 90.Adequacy U0126 FDA of empiric antibiotic treatmentEmpiric treatment was adequate in 95% of patients. The mean duration of antibiotic treatment for VAP was 10.4 �� 5.2 days overall and 11.3 �� 5.2 days in patients alive at ICU discharge.Risk factors for ventilator-associated pneumoniaBy univariate analysis (Table (Table5),5), male sex and transport out of the ICU were strongly associated with VAP. Both consciousness alterations and enteral nutrition showed trends toward associations with VAP.

In contrast, VAP was not associated with NMBA use, stress-ulcer prophylaxis (proton-pump inhibitors, sucralfate, H2-blockers, or antacids), ARDS severity, or admission SAPS II score. All factors listed in Table Table66 were entered into the multistate model. Male sex, baseline Glasgow Coma Scale score, tracheostomy (protective), enteral nutrition (protective), and the use of a subglottic secretion-drainage system (protective) were independently associated with VAP.Table 5Risk factors potentially associated with VAPTable 6Risk factors associated with the occurrence of bacterial VAPDiscussionOur study has three main findings. First, bacterial VAP was diagnosed in approximately one third of patients with severe ARDS. Second, VAP was associated with a higher crude ICU mortality rate.

However, no effect of VAP on ICU mortality was found after adjustment. Third, male sex and baseline Glasgow Coma Scale score were associated with VAP in our patients with severe ARDS, whereas tracheostomy, enteral nutrition, and the use of a subglottic secretion-drainage system were protective.Study rationaleAlthough several [6-10] studies evaluated the incidence of VAP in patients with ARDS, only one [8] sought to identify specific risk factors for VAP, and all but one [8] used a single-center design. These studies included 30 to 134 ARDS patients (Table (Table7).7). Much more important, they were performed before the widespread use of lung-protective ventilation. To our knowledge, the epidemiology and outcomes of VAP have not been evaluated in ARDS patients receiving a strictly standardized protocol of lung-protective mechanical ventilation [12].

This standardization is important, as recent evidence indicates that cyclic stretching of lung cells promotes bacterial Dacomitinib growth [11], suggesting that variations in the ventilation strategy may affect the risk of VAP.Table 7Main studies related to the epidemiology of VAP in ARDS patientsIncidence of ventilator-associated pneumoniaNone of the patients received new antibiotics before BAL or mini-BAL. Thus, the 28.

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