TY - JOUR
T1 - Ventilator-associated pneumonia during weaning from mechanical ventilation
T2 - Role of fluid management
AU - Dessap, Armand Mekontso
AU - Katsahian, Sandrine
AU - Roche-Campo, Ferran
AU - Varet, Hugo
AU - Kouatchet, Achille
AU - Tomicic, Vinko
AU - Beduneau, Gaetan
AU - Sonneville, Romain
AU - Jaber, Samir
AU - Darmon, Michael
AU - Castanares-Zapatero, Diego
AU - Brochard, Laurent
AU - Brun-Buisson, Christian
PY - 2014/7
Y1 - 2014/7
N2 - BACKGROUND: Pulmonary 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. M ETHODS: We 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 biomarkerdriven, 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). R ESULTS: Among 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= 5 .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 =5 .02 and 0.50 [0.25-0.96], P= 5 .03, respectively). CONCLUSIONS: Using proper competing risk analyses, we found that a depletive fluidmanagement strategy, when initiating the weaning process, has the potential for lowering VAP risk in patients who are mechanically ventilated.
AB - BACKGROUND: Pulmonary 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. M ETHODS: We 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 biomarkerdriven, 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). R ESULTS: Among 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= 5 .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 =5 .02 and 0.50 [0.25-0.96], P= 5 .03, respectively). CONCLUSIONS: Using proper competing risk analyses, we found that a depletive fluidmanagement strategy, when initiating the weaning process, has the potential for lowering VAP risk in patients who are mechanically ventilated.
UR - http://www.scopus.com/inward/record.url?scp=84903822113&partnerID=8YFLogxK
U2 - 10.1378/chest.13-2564
DO - 10.1378/chest.13-2564
M3 - Article
C2 - 24652410
AN - SCOPUS:84903822113
SN - 0012-3692
VL - 146
SP - 58
EP - 65
JO - Chest
JF - Chest
IS - 1
ER -