Ventilator associated-lower respiratory tract infections (VA-LRTIs), either ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), accounts for most nosocomial infections in intensive care units (ICU) including. Our aim was to determine if appropriate antibiotic treatment in patients with VA-LRTI will effectively reduce mortality in patients who had cardiovascular failure. Methods: This was a pre-planned subanalysis of a large prospective cohort of mechanically ventilated patients for at least 48 h in eight countries in two continents. Patients with a modified Sequential Organ Failure Assessment (mSOFA) cardiovascular score of 4 (at the time of VA-LRTI diagnosis and needed be present for at least 12 h) were defined as having cardiovascular failure. Results: VA-LRTI occurred in 689 (23.2%) out of 2960 patients and 174 (25.3%) developed cardiovascular failure. Patients with cardiovascular failure had significantly higher ICU mortality than those without (58% vs. 26.8%; p < 0.001; OR 3.7; 95% CI 2.6-5.4). A propensity score analysis found that the presence of inappropriate antibiotic treatment was an independent risk factor for ICU mortality in patients without cardiovascular failure, but not in those with cardiovascular failure. When the propensity score analysis was conducted in patients with VA-LRTI, the use of appropriate antibiotic treatment conferred a survival benefit for patients without cardiovascular failure who had only VAP. Conclusions: Patients with VA-LRTI and cardiovascular failure did not show an association to a higher ICU survival with appropriate antibiotic treatment. Additionally, we found that in patients without cardiovascular failure, appropriate antibiotic treatment conferred a survival benefit for patients only with VAP.

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Estudio de cohorte para evaluar la asociación entre el tiempo de inicio de nutrición con días de ventilación mecánica invasiva en pacientes con choque séptico Cohort study to evaluate the association between the start time of nutrition with days of invasive mechanical ventilation in patients with septic shock Estudo de coorte para avaliar a associação entre o tempo de início da nutrição com os dias de ventilação mecânica invasiva em pacientes com choque séptico

Hipoxemia y mecánica ventilatoria en pacientes con infección por coronavirus asociado a síndrome respiratorio agudo grave-2 Hypoxemia and respiratory mechanics in patients with severe acute respiratory syndrome-coronavirus 2 infection Hipoxemia e mecânica ventilatória em pacientes com infecção por coronavírus 2-síndrome respiratória aguda grave

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