Effects of Different Inhalation Therapy on Ventilator-Associated Pneumonia in Ventilated COVID-19 Patients: A Randomized Controlled Trial
Nikola Delić, Andrija Matetic, Josipa Domjanović, Toni Kljaković-Gašpić, Lenko Šarić, Darko Ilić, Svjetlana Došenović, Josipa Domazet, Ruben Kovač, Frane Runjić, Sanda Stojanović Stipić, Božidar Duplančić
Microorganisms, doi:10.3390/microorganisms10061118
The effect of routine inhalation therapy on ventilator-associated pneumonia (VAP) in mechanically ventilated patients with the coronavirus disease (COVID-19) has not been well-defined. This randomized controlled trial included 175 eligible adult patients with COVID-19 who were treated with mechanical ventilation at the University Hospital of Split between October 2020 and June 2021. Patients were randomized and allocated to a control group (no routine inhalation) or one of the treatment arms (inhalation of N-acetylcysteine; 5% saline solution; or 8.4% sodium bicarbonate). The primary outcome was the incidence of VAP, while secondary outcomes included all-cause mortality. Routine inhalation therapy had no effect on the incidence of bacterial or fungal VAP nor on all-cause mortality (p > 0.05). Secondary analyses revealed a significant reduction of Gram-positive and methicillin-resistant Staphylococcus aureus (MRSA) VAP in the treatment groups. Specifically, the bicarbonate group had a statistically significantly lower incidence of Gram-positive bacterial VAP (4.8%), followed by the N-acetylcysteine group (10.3%), 5% saline group (19.0%), and control group (34.6%; p = 0.001). This difference was driven by a lower incidence of MRSA VAP in the bicarbonate group (2.4%), followed by the N-acetylcysteine group (7.7%), 5% saline group (14.3%), and control group (34.6%; p < 0.001). Longer duration of ventilator therapy was the only significant, independent predictor of any bacterial or fungal VAP in the multivariate analysis (aOR 1.14, 95% CI 1.01-1.29, p = 0.038 and aOR 1.05, 95% CI 1.01-1.10, p = 0.028, respectively). In conclusion, inhalation therapy had no effect on the overall VAP incidence or all-cause mortality. Further studies should explore the secondary findings of this study such as the reduction of Gram-positive or MRSA-caused VAP in treated patients.
Conflicts of Interest: The authors declare no conflict of interest.
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'abstract': '<jats:p>The effect of routine inhalation therapy on ventilator-associated pneumonia (VAP) in '
'mechanically ventilated patients with the coronavirus disease (COVID-19) has not been '
'well-defined. This randomized controlled trial included 175 eligible adult patients with '
'COVID-19 who were treated with mechanical ventilation at the University Hospital of Split '
'between October 2020 and June 2021. Patients were randomized and allocated to a control group '
'(no routine inhalation) or one of the treatment arms (inhalation of N-acetylcysteine; 5% '
'saline solution; or 8.4% sodium bicarbonate). The primary outcome was the incidence of VAP, '
'while secondary outcomes included all-cause mortality. Routine inhalation therapy had no '
'effect on the incidence of bacterial or fungal VAP nor on all-cause mortality (p > 0.05). '
'Secondary analyses revealed a significant reduction of Gram-positive and '
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