Abstract
BACKGROUND. Despite guidelines promoting the prevention and aggressive treatment of ventilator-associated pneumonia (VAP), the importance of VAP as a driver of outcomes in mechanically ventilated patients, including patients with severe COVID-19, remains unclear. We aimed to determine the contribution of unsuccessful treatment of VAP to mortality for patients with severe pneumonia. METHODS. We performed a single-center, prospective cohort study of 585 mechanically ventilated patients with severe pneumonia and respiratory failure, 190 of whom had COVID-19, who underwent at least 1 bronchoalveolar lavage. A panel of intensive care unit (ICU) physicians adjudicated the pneumonia episodes and endpoints on the basis of clinical and microbiological data. Given the relatively long ICU length of stay (LOS) among patients with COVID-19, we developed a machine-learning approach called CarpeDiem, which grouped similar ICU patient-days into clinical states based on electronic health record data. RESULTS. CarpeDiem revealed that the long ICU LOS among patients with COVID-19 was attributable to long stays in clinical states characterized primarily by respiratory failure. While VAP was not associated with mortality overall, the mortality rate was higher for patients with 1 episode of unsuccessfully treated VAP compared with those with successfully treated VAP (76.4% versus 17.6%, P < 0.001). For all patients, including those with COVID-19, CarpeDiem demonstrated that unresolving VAP was associated with a transitions to clinical states associated with higher mortality. CONCLUSIONS. Unsuccessful treatment of VAP is associated with higher mortality. The relatively long LOS for patients with COVID-19 was primarily due to prolonged respiratory failure, placing them at higher risk of VAP.
| Original language | English (US) |
|---|---|
| Article number | e170682 |
| Journal | Journal of Clinical Investigation |
| Volume | 133 |
| Issue number | 12 |
| DOIs | |
| State | Published - Jun 15 2023 |
Funding
FUNDING. National Institute of Allergy and Infectious Diseases (NIAID), NIH grant U19AI135964; National Heart, Lung, and Blood Institute (NHLBI), NIH grants R01HL147575, R01HL149883, R01HL153122, R01HL153312, R01HL154686, R01HL158139, P01HL071643, and P01HL154998; National Heart, Lung, and Blood Institute (NHLBI), NIH training grants T32HL076139 and F32HL162377; National Institute on Aging (NIA), NIH grants K99AG068544, R21AG075423, and P01AG049665; National Library of Medicine (NLM), NIH grant R01LM013337; National Center for Advancing Translational Sciences (NCATS), NIH grant U01TR003528; Veterans Affairs grant I01CX001777; Chicago Biomedical Consortium grant; Northwestern University Dixon Translational Science Award; Simpson Querrey Lung Institute for Translational Science (SQLIFTS); Canning Thoracic Institute of Northwestern Medicine. The authors would like to thank Malte Luecken and Neal Ravin-dra for valuable discussions. The NU SCRIPT Study was funded by the NIAID, NIH (U19AI135964). This work was also supported by the SQLIFTS and the Canning Thoracic Institute of Northwestern Medicine. CAG is supported by NHLBI, NIH Training grants (T32HL076139 and F32HL162377). TS is supported by the NIA, NIH (K99AG068544). YL is supported by the NIH (R01LM013337 and U01TR003528). GRSB is supported by the NIH (U19AI135964, P01AG049665, R01HL147575, P01HL071643, and R01HL154686); the US Department of Veterans Affairs (I01CX001777); a grant from the Chicago Biomedical Consortium; and a Northwestern University Dixon Translational Science Award. RGW is supported by NIH grants (U19AI135964, U01TR003528, P01HL154998, R01HL14988, and R01LM013337). AVM is supported by NIH grants (U19AI135964, P01AG049665, R21AG075423, R01HL158139, R01HL153312, and P01HL154998). BDS is supported by the NIH (R01HL149883, R01HL153122, P01HL154998, P01AG049665, and U19AI135964). The Graphical Abstract was created with BioRender.com.
ASJC Scopus subject areas
- General Medicine
