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• W4387249564 abstract "SESSION TITLE: Chest Infections Posters 7 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: Ventilator -associated bacterial pneumonia (VABP) is a serious complication of mechanical ventilation(MV) and the development of severe sepsis/septic shock as complication of VABP is crucial in term on increased in-intensive care unit (ICU) mortality in such patients.We aimed to descrive the risk factors for development of septic shock in patients with VABP in term on further evaluation of poor outcemes and their modification possibility for reduction mortality rate. METHODS: This was a retrospective cohort study including 132 VABP patients on MV from January 2018 to December 2022 in our ICU department of university hospital.We recorded baseline characteristics ,as well as,28-day mortality rate.Variables associated with of severe sepsis/septic shock development and mortality were determined by Cox regression model and Kaplan -Meier survival analysis. RESULTS: Severe sepsis/septic shock has developed in 72 of 132 patients (54.5%) and the most important risk factors predicting development of severe sepsis/septic shock in patients with VABP were older age (>65 yers old),(p<.01), huge Charlson comorbidity index (6.2[2.8-7,4];p<.03), malnurtation(4.5[2.4-5.8];p<0.01); pleural effusion (3.7[2.1-5.4];p<.01), and bilateral and multi-lobar lung infiltrates were most common findings which are associated with development of septic shock in VABP patients (4.8[2.9-7.4];p<0.003). Gram -negative agents were the major of finding pathogens and the account of Acinotebacter baumannii was with high account among others (38% of all pathoegns). Among patients with septic shock associated VABP the gravity of muti-drug resistant pathogens was higher (3.2[1.4-5.2];p<0.001) and it was associated with significantly higher length of ventilation (LOV) and the length of ICU stay (LOSicu) which are associated with increased risk of severe sepsis/septic shock and in ICU mortality (p<.01). The ventilator days to event (IQR) was higher in patients with septic shock associated VABP(3.1[1.88-5.1];p<.001), ventilator duration in these patients also was higher (p<.001) compared to non-septic shock VABP patients, and ICU LOS also was higher in these patients ((p<.001). Serum lactate level was higher (p<.001) and the persistent ( progressive or temporal changable ) procalsitonin level was also higher compared to non-septic VABP patients (p<.004). In-ICU mortality was higher among septic VABP patients compared to non-septic VABP patients (52.7% vs 23.3%,respecively;p<.01) Risk factors for in -ICU mortality in such patients were older age(p<.01), malnutration(p<.01), Charlson comorbidity index (5.5[3.8-6.2];p<.04), acute respiratory distress syndrome (ARDS)(6.4[2.9-10.4];p<.001), high SOFA score (>5) and the use of vasoactive drugs during the episode were associated with higher mortality rate in such patients (p<.001). Low PaO2/FiO2 value also was associated with higher mortality rate in such patients (p<.004). CONCLUSIONS: We found a high burden of comorbidities in our septic shock VABP patients ,mostly related to neurological conditions, underlying chronic obstructive pulmonary disease,and malnutration,as well as considerably high 28-day mortality rate.Bilateral and multi-lobar lung infiltrates and also pleural effusions commonly predicts the MDR-pathogen associated VABP which were significantly associated with development of septic VABP.We identified factors associated fatal outcomes ,which could help identify patients who might benefit from adequate fluid resuscitation for prevention of tissue hypoperfusion and early empiric antibiotic treatment,as well as determine prognosis.These findings should be validated by studies with larger samples of patients. CLINICAL IMPLICATIONS: The result of our study might be benefical for pulmonologists, researches, intensive care unit physicians, intensivists, pulmonary department nurses, critical care nurses DISCLOSURES: No relevant relationships by Alizamin Sadigov" @default.
• W4387249564 created "2023-10-03" @default.
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• W4387249564 date "2023-10-01" @default.
• W4387249564 modified "2023-10-03" @default.
• W4387249564 title "VENTILATOR-ASSOCIATED BACTERIAL PNEUMONIA IN PATIENTS WITH AND WITHOUT SEPTIC SHOCK: RISK FACTORS PREDICTING POOR PATIENT OUTCOMES" @default.
• W4387249564 doi "https://doi.org/10.1016/j.chest.2023.07.560" @default.
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