Hyperbaric hyperoxemia as a risk factor for ventilator-acquired pneumonia?

<h4>Objectives</h4>Ventilator-acquired pneumonia (VAP) is the leading cause of serious associated infections in Intensive Care Units (ICU) and is associated with significant morbidity. The use of hyperbaric oxygen therapy (HBOT) in patients on mechanical ventilation may increase exposure...

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Autores principales:	Morgan Caplan, Thibault Duburcq, Anne-Sophie Moreau, Julien Poissy, Saad Nseir, Erika Parmentier-Decrucq
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/8d8a2991175a41448bb78f34d4a27832
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spelling	oai:doaj.org-article:8d8a2991175a41448bb78f34d4a278322021-12-02T20:10:13ZHyperbaric hyperoxemia as a risk factor for ventilator-acquired pneumonia?1932-620310.1371/journal.pone.0253198https://doaj.org/article/8d8a2991175a41448bb78f34d4a278322021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0253198https://doaj.org/toc/1932-6203<h4>Objectives</h4>Ventilator-acquired pneumonia (VAP) is the leading cause of serious associated infections in Intensive Care Units (ICU) and is associated with significant morbidity. The use of hyperbaric oxygen therapy (HBOT) in patients on mechanical ventilation may increase exposure to certain risk factors such as hyperoxemia and the need for multiple transfers. The aim of our study was to assess the relationship between HBOT and VAP.<h4>Method</h4>This retrospective observational study was performed from March 2017 to March 2018 in a 10-bed ICU using HBOT. All patients receiving mechanical ventilation (MV) for more than 48 hours were eligible. VAP was defined using clinical and radiological criteria. Data collection was carried out via digital medical records. Risk factors for VAP were determined by univariate and multivariate analysis.<h4>Results</h4>Forty-two (23%) of the 182 patients enrolled developed at least one episode of VAP. One hundred and twenty-four (68%) patients received HBOT. The incidence rate of VAP was 34 per 1000 ventilator days. The occurrence of VAP was significantly associated with immunosuppression (p<0.029), MV duration (5 [3-7] vs 8 [5-11.5] days, p<0.0001), length of stay (8 [5-13] vs 19.5 [13-32] days, p<0.0001), reintubation (p<0.0001), intra-hospital transport (p = 0.001), use of paralytic agents (p = 0.013), tracheotomy (p = 0.003) and prone position (p = 0.003). The use of HBOT was not associated with the occurrence of VAP. Multivariate analysis identified reintubation (OR: 8.3 [2.6-26.6]; p<0.0001), intra-hospital transport (OR: 3.5 [1.3-9.2]; p = 0.011) and the use of paralytic agents (OR: 3.3 [1.3-8.4]; p = 0.014) as independent risk factors for VAP.<h4>Conclusion</h4>Known risk factors for VAP are to be found within our ICU population. HBOT, however, is not an extra risk factor for VAP within this group. Further experimental and clinical investigations are needed to understand the impact of HBOT on the occurrence of VAP and on physiological microbiome.Morgan CaplanThibault DuburcqAnne-Sophie MoreauJulien PoissySaad NseirErika Parmentier-DecrucqPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0253198 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Morgan Caplan Thibault Duburcq Anne-Sophie Moreau Julien Poissy Saad Nseir Erika Parmentier-Decrucq Hyperbaric hyperoxemia as a risk factor for ventilator-acquired pneumonia?
description	<h4>Objectives</h4>Ventilator-acquired pneumonia (VAP) is the leading cause of serious associated infections in Intensive Care Units (ICU) and is associated with significant morbidity. The use of hyperbaric oxygen therapy (HBOT) in patients on mechanical ventilation may increase exposure to certain risk factors such as hyperoxemia and the need for multiple transfers. The aim of our study was to assess the relationship between HBOT and VAP.<h4>Method</h4>This retrospective observational study was performed from March 2017 to March 2018 in a 10-bed ICU using HBOT. All patients receiving mechanical ventilation (MV) for more than 48 hours were eligible. VAP was defined using clinical and radiological criteria. Data collection was carried out via digital medical records. Risk factors for VAP were determined by univariate and multivariate analysis.<h4>Results</h4>Forty-two (23%) of the 182 patients enrolled developed at least one episode of VAP. One hundred and twenty-four (68%) patients received HBOT. The incidence rate of VAP was 34 per 1000 ventilator days. The occurrence of VAP was significantly associated with immunosuppression (p<0.029), MV duration (5 [3-7] vs 8 [5-11.5] days, p<0.0001), length of stay (8 [5-13] vs 19.5 [13-32] days, p<0.0001), reintubation (p<0.0001), intra-hospital transport (p = 0.001), use of paralytic agents (p = 0.013), tracheotomy (p = 0.003) and prone position (p = 0.003). The use of HBOT was not associated with the occurrence of VAP. Multivariate analysis identified reintubation (OR: 8.3 [2.6-26.6]; p<0.0001), intra-hospital transport (OR: 3.5 [1.3-9.2]; p = 0.011) and the use of paralytic agents (OR: 3.3 [1.3-8.4]; p = 0.014) as independent risk factors for VAP.<h4>Conclusion</h4>Known risk factors for VAP are to be found within our ICU population. HBOT, however, is not an extra risk factor for VAP within this group. Further experimental and clinical investigations are needed to understand the impact of HBOT on the occurrence of VAP and on physiological microbiome.
format	article
author	Morgan Caplan Thibault Duburcq Anne-Sophie Moreau Julien Poissy Saad Nseir Erika Parmentier-Decrucq
author_facet	Morgan Caplan Thibault Duburcq Anne-Sophie Moreau Julien Poissy Saad Nseir Erika Parmentier-Decrucq
author_sort	Morgan Caplan
title	Hyperbaric hyperoxemia as a risk factor for ventilator-acquired pneumonia?
title_short	Hyperbaric hyperoxemia as a risk factor for ventilator-acquired pneumonia?
title_full	Hyperbaric hyperoxemia as a risk factor for ventilator-acquired pneumonia?
title_fullStr	Hyperbaric hyperoxemia as a risk factor for ventilator-acquired pneumonia?
title_full_unstemmed	Hyperbaric hyperoxemia as a risk factor for ventilator-acquired pneumonia?
title_sort	hyperbaric hyperoxemia as a risk factor for ventilator-acquired pneumonia?
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/8d8a2991175a41448bb78f34d4a27832
work_keys_str_mv	AT morgancaplan hyperbarichyperoxemiaasariskfactorforventilatoracquiredpneumonia AT thibaultduburcq hyperbarichyperoxemiaasariskfactorforventilatoracquiredpneumonia AT annesophiemoreau hyperbarichyperoxemiaasariskfactorforventilatoracquiredpneumonia AT julienpoissy hyperbarichyperoxemiaasariskfactorforventilatoracquiredpneumonia AT saadnseir hyperbarichyperoxemiaasariskfactorforventilatoracquiredpneumonia AT erikaparmentierdecrucq hyperbarichyperoxemiaasariskfactorforventilatoracquiredpneumonia
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Hyperbaric hyperoxemia as a risk factor for ventilator-acquired pneumonia?

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