Clinical trial NCT03348579: Hospital-acquired Pneumonia in Intensive Care Unit
Official title: Hospital Acquired and Ventilator Associated Pneumonia : Impact of the New French Guidelines on Patients Care and Outcomes.
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Hospital Acquired Pneumonia
Ventilator-Associated Pneumonia
Sepsis
Pneumonia
Keywords: Intensive care unit
Pneumonia
Ventilator associated
Hospital acquired pneumonia
Guidelines
Lead sponsor: Nantes University Hospital
Sponsor class: OTHER
Collaborators: name: Société Française d'Anesthésie et de Réanimation
First posted: 2017-11-21
Enrollment: 1850
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_ONLY
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: adult patients hospitalized in intensive care units with a hospital stay greater than 72 hours and a GIs-II greater than or equal to 15.

Brief summary: hospital-acquired pneumonia are a common disease in intensive care unit. The prevention, the diagnosis and the treatment of hospital acquired pneumonia are a frequent challenge. Nevertheless it seems that there are great differences in standard of care between hospitals. The investigators hypothesized that medical education and implementation of evidence-base guidelines can reduce the duration of mechanical ventilation in patients presenting of hospital acquired pneumonia

Detailed description: The before period (phase 1) will consist of all consecutive patients admitted to the participating ICUs before the national guidelines publication concerning healthcare associated pneumonia.

The second period (phase 2) will consist of all consecutive patients admitted to the participating ICUs after the publication of the national guidelines publication concerning healthcare associated pneumonia.

Afterward, an interphase will occur during which all physicians, residents, physiotherapists and nurses will receive a formal training for the processes and procedures related to the new guidelines published in september 2017.

In the intervention group, on top of the standard training, the centers receive an analysis of the evolution of the practices of their center and the future of their patients between phases 1 and 2, as well as these same values for the data set. The centers are then called to conduct a meeting to determine their priority improvement points based on this audit.

The third and final period (phase 3) will consist of all consecutive patients admitted to the participating ICUs after the formal training.

Eligibility criteria: Inclusion Criteria:

* Age \> 18 years ; IGS-II score \> 15 ; Hospital stay \>= 3 days

Exclusion Criteria:

* Community-acquired pneumonia, pregnant women, refusal to participate

Primary outcomes:
measure: Unit length of stay
timeFrame: 28 days
Secondary outcomes:
measure: Intensive Care Unit free-days at day 28
timeFrame: 28 days
measure: Hospital-acquired pneumonia
timeFrame: 28 days
measure: Composite measure of compliance to guidelines
timeFrame: 28 days
measure: Empirical treatment failure
timeFrame: 28 days
Other outcomes:
Locations:
city: Nantes
country: France
facility: CHU de NANTES
Study officials:
affiliation: Nantes University Hospital
name: Antoine Roquilly, PH
role: PRINCIPAL_INVESTIGATOR
affiliation: AP-HM
name: Marc Leone
role: PRINCIPAL_INVESTIGATOR
References:
citation: Roquilly A, Chanques G, Lasocki S, Foucrier A, Fermier B, De Courson H, Carrie C, Danguy des Deserts M, Gakuba C, Constantin JM, Lagarde K, Holleville M, Blidi S, Sossou A, Cailliez P, Monard C, Oudotte A, Mathieu C, Bourenne J, Isetta C, Perrigault PF, Lakhal K, Rouhani A, Asehnoune K, Guerci P, Tran Dinh A, Chousterman B, Cupaciu A, Dahyot-Fizelier C, Bellier R, Au Duong J, Mansour A, Morel J, Beauplet G, Vibet MA, Feuillet F, Sebille V, Leone M. Implementation of French Recommendations for the Prevention and the Treatment of Hospital-acquired Pneumonia: A Cluster-randomized Trial. Clin Infect Dis. 2021 Oct 5;73(7):e1601-e1610. doi: 10.1093/cid/ciaa1441.