Incidence and Risk Factors of Ventilator-Associated Pneumonia in Cardiac Arrest in Patients With Selective Digestive Decontamination.

Background

Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality. Temperature management (TM) is recommended since hyperthermia is associated with worse outcomes. Pneumonia is a frequent occurrence following OHCA, and some studies suggest that TM may have a negative impact on its development. Selective digestive decontamination (SDD) is used in some centers to reduce the incidence of pneumonia in intensive care unit (ICU), but its use remains controversial. This study aims to assess the incidence, risk factors and clinical course of VAP after OHCA.

Methods

We conducted a retrospective cohort study on 169 consecutive OHCA patients after their admission in ICU. All patients were treated with TM and SDD. Pharyngeal swabs were analyzed twice weekly. The primary outcome was the incidence of VAP and non-VAP. Secondary aim was to identify the risk factors associated with VAP and its effect on patients' outcome.

Results

Incidence of VAP was 5.3%, while incidence of non-VAP was 9.5%. In multivariate analysis, male gender (sHR 3.01; CI 1.1-7.9), increase of white blood cells (WBC) count > 30% over 5 days (sHR 2.32; CI 1.23-3.9), heart disease (sHR 2.4; CI 1.36-4.59), and bacterial colonization of the pharynx (sHR 2.79; CI 1.13-4.39) were significantly associated with VAP.

Conclusions

Pharyngeal colonization could be useful to identify patients at higher risk of VAP development. The low rate of VAP in this cohort suggests that SDD can prevent VAP after OHCA. Further studies are needed to explore the potential of SDD in OHCA patients.