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Around one-third of patients diagnosed with COVID-19 develop a severe illness that requires admission to the Intensive Care Unit (ICU). In clinical practice, clinicians have learned that patients admitted to the ICU due to severe COVID-19 frequently develop ventilator-associated lower respiratory tract infections (VA-LRTI). This study aims to describe the clinical characteristics, the factors associated with VA-LRTI, and its impact on clinical outcomes in patients with severe COVID-19. This was a multicentre, observational cohort study conducted in ten countries in Latin America and Europe. We included patients with confirmed rtPCR for SARS-CoV-2 requiring ICU admission and endotracheal intubation. Only patients with a microbiological and clinical diagnosis of VA-LRTI were included. Multivariate Logistic regression analyses and Random Forest were conducted to determine the risk factors for VA-LRTI and its clinical impact in patients with severe COVID-19. In our study cohort of 3287 patients, VA-LRTI was diagnosed in 28.8% [948/3287]. The cumulative incidence of ventilator-associated pneumonia (VAP) was 18.6% [610/3287], followed by ventilator-associated tracheobronchitis (VAT) 10.3% [338/3287]. A total of 1252 bacteria species were isolated. The most frequently isolated pathogens were Pseudomonas aeruginosa (21.2% [266/1252]), followed by Klebsiella pneumoniae (19.1% [239/1252]) and Staphylococcus aureus (15.5% [194/1,252]). The factors independently associated with the development of VA-LRTI were prolonged stay under invasive mechanical ventilation, AKI during ICU stay, and the number of comorbidities. Regarding the clinical impact of VA-LRTI, patients with VAP had an increased risk of hospital mortality (OR [95% CI] of 1.81 [1.40–2.34]), while VAT was not associated with increased hospital mortality (OR [95% CI] of 1.34 [0.98–1.83]). VA-LRTI, often with difficult-to-treat bacteria, is frequent in patients admitted to the ICU due to severe COVID-19 and is associated with worse clinical outcomes, including higher mortality. Identifying risk factors for VA-LRTI might allow the early patient diagnosis to improve clinical outcomes.Trial registration: This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.

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Purpose The purpose of this paper is evaluate to what extent consumers can recognise a scent within a context that is congruent either with the product or with the user, respectively, objects’ quality or subjects’ involvement. Design/methodology/approach This paper consists of two experimental studies. The first study assesses people’s capacity to recognise three scents: leather, synthetic leather, and fabric. The second study assesses the way in which a frame of reference (quality or involvement) affects people’s capacity for scent recognition (leather and fabric). Findings Results confirm the difficulty of scent recognition revealing, in the first study, a low level of consistency in subjects’ responses. The second study shows an interaction between the type of scent and consumers’ framework: subjects who are primed to think about product quality present more accurate scent recognition when they smell leather, whereas subjects who are primed to think about themselves present more accurate scent recognition when they smell fabric. Practical implications These results can be used in brand communication. A scent, such as that of leather, should highlight quality attributes in its communication. If the product is unscented, communication should highlight the subject who uses the product. Originality/value Previous studies show the importance of the consistency between scent and product marketing strategies. This study complements these findings by differentiating the context where a scent is presented considering either the product (the object’s quality attributes) or the individual who uses that product (subject’s involvement).