Am. J. Respir. Crit. Care Med., Volume 161, Number 6, June 2000, 1942-1948

Multicenter Prospective Study of Ventilator-Associated Pneumonia During Acute Respiratory Distress Syndrome
Incidence, Prognosis, and Risk Factors

PHILIPPE MARKOWICZ, MICHEL WOLFF, KAMEL DJEDAÏNI, YVES COHEN, JEAN CHASTRE, CHRISTOPHE DELCLAUX, JACQUES MERRER, BERNARD HERMAN, BENOIT VEBER, ALAIN FONTAINE, DIDIER DREYFUSS, and the ARDS Study Group

We investigated the incidence, risk factors for, and outcome of ventilator-associated pneumonia (VAP) in patients with acute respiratory distress syndrome (ARDS). We compared 134 patients with ARDS with 744 patients without ARDS on mechanical ventilation. Fiberoptic bronchoscopic examination and quantitative bacterial cultures (protected brush or catheter sampling [threshold: 10³ cfu/ml], or bronchoalveolar lavage [threshold: 10⁴ cfu/ml]) were used to diagnose pneumonia. VAP occurred in 49 patients (36.5%). The incidence of pneumonia was 23% (173 of 744 patients) among patients without ARDS (p < 0.002). Nonfermenting gram-negative rods caused significantly more pneumonia in ARDS patients. Mortality rates were identical in ARDS patients with (28 of 49 patients, 57%) and without (50 of 85 patients, 59%) pulmonary infection (p = 0.8). VAP resulted in a considerable increase in attributable time on mechanical ventilation of both the overall population of ARDS patients 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 duration of exposure to sucralfate (adjusted OR: 1.206; 95% CI: 1.095 to 1.328, p = 0.0002) were associated with an increased risk of VAP during ARDS. VAP considerably prolongs the time on mechanical ventilation without affecting survival. Patients given sucralfate may be at greater risk of developing pulmonary infection during ARDS.

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