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Risk factors for ventilator-associated pneumonia in patients with acute respiratory distress syndrome due to COVID-19
Factores de riesgo de neumonía asociada a la ventilación mecánica en pacientes con síndrome de dificultad respiratoria aguda causado por COVID-19
DOI:
https://doi.org/10.15446/revfacmed.v72n2.109746Palabras clave:
COVID-19, SARS-CoV-2, Nosocomial infections, Ventilator-associated pneumonia, Acute Respiratory Distress Syndrome, Critical Care (en)COVID-19, SARS-CoV-2, Infecciones nosocomiales, Neumonía asociada a ventilador, Síndrome de dificultad respiratoria aguda, Cuidados críticos (es)
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Introduction: Ventilator-associated pneumonia (VAP) is a common complication in patients on mechanical ventilation that has been associated with a worse prognosis. During the COVID-19 pandemic, the frequency of VAP increased.
Objective: To identify risk factors for VAP in patients with acute respiratory distress syndrome due to COVID-19 (C-ARDS) admitted to an intensive care unit (ICU) in Bogotá, Colombia.
Materials and methods: Nested case-control study. The cohort comprised adult patients with C-ARDS on mechanical ventilation who were admitted to the ICU between May 2020 and June 2021. Patients with VAP were included as cases, and four controls who did not have VAP at the time of the case occurrence were randomly selected from the cohort for each case. Bivariate analyses were performed to evaluate differences between groups, as well as a multivariate analysis (conditional logistic regression model) to determine the association between the variables considered and the development of VAP, calculating odds ratios (OR) (crude and adjusted) and their respective 95% confidence intervals (95%CI).
Results: The cohort comprised 870 patients, of whom 350 were included in the final sample (70 cases and 280 controls). Of these, 68.28% were male, and the mean age was 58 years (±12.5). High blood pressure (40.00%) and diabetes mellitus (20.00%) were the most frequent comorbidities. The following factors were associated with the development of VAP in the multivariate analysis: male sex (aOR: 2.29, 95%CI: 1.2-4.3), days on invasive mechanical ventilation (IMV) (aOR: 1.05, 95%CI: 1.02-1.08), and use of neuromuscular blocking agents (aOR: 3.58, 95%CI: 1.35-9.4).
Conclusion: Male sex, days on IMV, and use of neuromuscular blockers behaved as risk factors for VAP.
Introducción. La neumonía asociada a la ventilación mecánica (NAVM) es una complicación frecuente en los pacientes en ventilación mecánica que se asocia con un peor pronóstico y cuya frecuencia aumentó durante la pandemia por COVID-19.
Objetivo. Identificar los factores de riesgo de NAVM en pacientes con síndrome de dificultad respiratoria aguda por COVID-19 (SDRA-C) admitidos a una unidad de cuidados intensivos (UCI) de Bogotá D.C., Colombia.
Materiales y métodos. Estudio de casos y controles anidado. La cohorte estuvo conformada por pacientes adultos con SDRA-C en ventilación mecánica que fueron admitidos a la UCI entre mayo de 2020 y junio de 2021; los pacientes con NAVM fueron incluidos como casos y, por cada caso, se seleccionaron aleatoriamente cuatro controles de la cohorte que al momento de la aparición del caso no tuvieran NAVM. Se realizaron análisis bivariados para evaluar las diferencias entre grupos y un análisis multivariado (modelo de regresión logística condicional) para determinar la asociación entre las variables consideradas y el desarrollo de NAVM mediante el cálculo de Odds ratios (OR) (crudos y ajustados) y sus respectivos intervalos de confianza al 95% (IC95%).
Resultados. La cohorte estuvo compuesta por 870 pacientes, de los cuales 350 fueron incluidos en la muestra final (70 casos y 280 controles). De estos, 68.28% eran hombres y la edad promedio fue 58 años (±12.5). La hipertensión arterial (40.00%) y la diabetes mellitus (20.00%) fueron las comorbilidades más frecuentes. En el análisis multivariado los siguientes factores se asociaron con el desarrollo de NAVM: sexo masculino (ORa: 2.29, IC95%: 1.2-4.3), días en ventilación mecánica invasiva (VMI) (ORa: 1.05, IC95%: 1.02-1.08) y uso de bloqueadores neuromusculares (ORa: 3.58, IC95%: 1.35-9.4).
Conclusión. El sexo masculino, los días en VMI y el uso de bloqueadores neuromusculares se comportaron como factores de riesgo de NAVM.
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