Describe the characteristics of ventilation-acquired pneumonia (VAP) and potential risk factors in critically ill Sars-Cov-2 patients admitted in three French public hospitals during the first year of the COVID-19 pandemic. We conducted a monocentric retrospective study in seven Marseille intensive care units (ICUs) aiming to describe VAP characteristics and identify their risk factors. VAP patients were compared to a non-VAP control group. From March to November 2020, 161 patients admitted for viral-induced acute respiratory failure (ARF) requiring invasive mechanical ventilation (IMV) were included. This cohort was categorized in two groups according to the development or not of a VAP during their stay in ICU. 82 patients (51%) developed ventilation-acquired pneumonia. Most of them were men (77%) and 55% had hypertension. In the VAP population, 31 out of 82 patients (38%) had received dexamethasone and 47% were administered antibiotic course prior to ICU admission. An amount of 88% of respiratory infections were late VAPs with a median delay of 10 days from the onset of IMV. Gram negative bacteria were responsible for 62% of VAPs with Pseudomonas spp. being the most documented bacteria. Less than a third of the ICU-acquired infections were due to multidrug resistant (MDR) bacteria mainly displaying AmpC cephalosporin hyper production resistance phenotype. Multivariate analysis revealed that early Dexamethasone administration in ICU, male sex, older age and ROX score were risk factors for VAP whereas pre-ICU antimicrobial treatment and higher IGS 2 were protective factors. VAP is a frequent ICU-related complication affecting half of patients infected with Sars-Cov-2 and requiring IMV. It was responsible for increased morbidity due to a longer ICU and hospital stay. VAP risk factors included demographic factors such as age and sex. Dexamethasone was associated with a threefold greater risk of developing VAP during ICU stay. These results need to be comforted by large multi-centric studies before questioning the only available and effective treatment against Sars-Cov-2 in ICU patients.

BackgroundAspiration pneumonia is the most common respiratory complication following out-of-hospital cardiac arrests (OHCA). Alpha-amylase (α-amylase) in pulmonary secretions is a biomarker of interest in detecting inhalation. The main goal of this study is to evaluate the performance of bronchoalveolar levels of α-amylase in early diagnosis of aspiration pneumonia, in patients admitted to intensive care unit (ICU) after OHCA.MethodsThis is a prospective single-center trial, led during 5 years (July 2015 to September 2020). We included patients admitted to ICU after OHCA. A protected specimen bronchial brushing and a mini-bronchoalveolar lavage (mini-BAL) were collected during the first 6 h after admission. Dosage of bronchial α-amylase and standard bacterial analysis were performed. Investigators confirmed pneumonia diagnosis using clinical, radiological, and microbiological criteria. Every patient underwent targeted temperature management.Results88 patients were included. The 34% (30 patients) developed aspiration pneumonia within 5 days following admission. The 55% (17) of pneumonias occurred during the first 48 h. The 57% of the patients received a prophylactic antibiotic treatment on their admission day. ICU mortality was 50%. Median value of bronchial α-amylase did not differ whether patients had aspiration pneumonia (15 [0–94]) or not (3 [0–61], p = 0,157). Values were significantly different concerning early-onset pneumonia (within 48 h) [19 (7–297) vs. 3 (0–82), p = 0,047]. If one or more microorganisms were detected in the initial mini-BAL, median value of α-amylase was significantly higher [25 (2–230)] than in sterile cultures (2 [0–43], p = 0,007). With an 8.5 IU/L cut-point, sensitivity and specificity of α-amylase value for predicting aspiration pneumonia during the first 2 days were respectively 74 and 62%. True positive and negative rates were respectively 44 and 86%. The area under the ROC curve was 0,654 (CI 95%; 0,524–0,785). Mechanical ventilation duration, length of ICU stay, and mortality were similar in both groups.ConclusionIn our study, dosage of bronchial α-amylase was not useful in predicting aspiration pneumonia within the first 5 days after ICU admission for OHCA. Performance in predicting early-onset pneumonia was moderate.

Introduction: Non-life-threatening blunt chest trauma (BCT) admitted in emergency department (ED) are at risk of acute respiratory failure (ARF) and respiratory complications during their intensive care unit (ICU) follow-up. They may require a special focus to adopt specific prophylactic strategies and proper orientation. The aim of this study was to identify different risk factors for ARF in mild BCT.Methods: This retrospective, monocentric study from January 2015 to December 2020 included all patients with mild BCT admitted to the ED and managed in ICU for at least 48 hours with spontaneous breathing at admission. Occurrence of ARF was defined by PaO2/FiO2 ratio (PaFI) under 200 and need of ventilator support in the first 72 hours after admission. Using univariate and multivariate analysis, the risk factors of ARF incidence after BCT were investigated. We also studied the global ability of the TTS score to predict ARF occurrence by a ROC curve. Finally, we assessed the most significant and sensitive TTS score threshold. Results: A total of 190 BCT patients was included and 23.7% of them developed an ARF. A TTS score greater than 8 was independently associated with early ARF. A TTS score threshold of 6 significantly predicted the ARF incidence with a sensitivity (91%) and negative predictor value (94%) in mild BCT. The others risk factors independently associated with ARF were chronic respiratory disease, high score SOFA and loco regional analgesia.Conclusion: A significant amount of risk factors of ARF following mild BCT were highlighted in our study and must be considered for the proper management of those patient. It is the first study to enhance that a low TTS score threshold could help the mass screening and proper orientation of mild BCT. This study provides the basis for the development of a new risk stratification tool (TTS score) for mild BCT patients who may develop respiratory complications.