{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T13:37:03Z","timestamp":1753882623302,"version":"3.41.2"},"reference-count":30,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V108C-057"],"award-info":[{"award-number":["V108C-057"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002701","name":"Ministry of Education","doi-asserted-by":"publisher","award":["The Featured Areas Research Center Program within"],"award-info":[{"award-number":["The Featured Areas Research Center Program within"]}],"id":[{"id":"10.13039\/501100002701","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005382","name":"National Yang-Ming University","doi-asserted-by":"publisher","award":["TVGH-NYMU-Excellent Physician Scientists Cultivati"],"award-info":[{"award-number":["TVGH-NYMU-Excellent Physician Scientists Cultivati"]}],"id":[{"id":"10.13039\/501100005382","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Respir Dis"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>Background:<\/jats:title><jats:p> Patients with severe influenza-related acute respiratory distress syndrome (ARDS) have high morbidity and mortality. Moreover, nosocomial lower respiratory tract infection (NLRTI) complicates their clinical management and possibly worsens their outcomes. This study aimed to explore the clinical features and impact of NLRTI in patients with severe influenza-related ARDS. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p> This was an institutional review board approved, retrospective, observational study conducted in eight medical centers in Taiwan. From January 1 to March 31 in 2016, subjects were enrolled from intensive care units (ICUs) with virology-proven influenza pneumonia, while all of those patients with ARDS requiring invasive mechanical ventilation and without bacterial community-acquired pneumonia (CAP) were analyzed. Baseline characteristics, critical-illness data and clinical outcomes were recorded. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> Among the 316 screened patients with severe influenza pneumonia, 250 with acute respiratory failure requiring intubation met the criteria of ARDS, without having bacterial CAP. Among them, 72 patients developed NLRTI. The independent risk factors for NLRTI included immunosuppressant use before influenza infection [odds ratio (OR), 5.669; 95% confidence interval (CI), 1.770\u201318.154], extracorporeal membrane oxygenation (ECMO) use after ARDS (OR, 2.440; 95% CI, 1.214\u20134.904) and larger corticosteroid dosage after ARDS (OR, 1.209; 95% CI, 1.038\u20131.407). Patients with NLRTI had higher in-hospital mortality and longer ICU stay, hospitalization and duration on mechanical ventilation. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion:<\/jats:title><jats:p> We found that immunosuppressant use before influenza infection, ECMO use, and larger steroid dosage after ARDS independently predict NLRTI in influenza-related ARDS. Moreover, NLRTI results in poorer outcomes in patients with severe influenza. The reviews of this paper are available via the supplemental material section. <\/jats:p><\/jats:sec>","DOI":"10.1177\/1753466620942417","type":"journal-article","created":{"date-parts":[[2020,7,28]],"date-time":"2020-07-28T02:53:54Z","timestamp":1595904834000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk factor analysis of nosocomial lower respiratory tract infection in influenza-related acute respiratory distress syndrome"],"prefix":"10.1177","volume":"14","author":[{"given":"Wei-Chih","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Chest Medicine, Taipei Veterans General Hospital, Taipei"},{"name":"Institute of Emergency and Critical Care Medicine and Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuo-Chin","family":"Kao","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan"},{"name":"Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chau-Chyun","family":"Sheu","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung"},{"name":"School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-Cheng","family":"Chan","sequence":"additional","affiliation":[{"name":"Division of Chest Medicine, Department of Internal Medicine, and Section of Critical Care and Respiratory Therapy, Taichung Veterans General Hospital, Taichung"},{"name":"Central Taiwan University of Science and Technology, Taichung"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Mu","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying-Chun","family":"Chien","sequence":"additional","affiliation":[{"name":"Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chung-Kan","family":"Peng","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinn-Jye","family":"Liang","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1603-868X","authenticated-orcid":false,"given":"Han-Chung","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan"},{"name":"Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-Ju","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung"},{"name":"School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen-Feng","family":"Fang","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung"},{"name":"Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wann-Cherng","family":"Perng","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao-Chien","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chieh-Liang","family":"Wu","sequence":"additional","affiliation":[{"name":"Center for Quality Management, Taichung Veterans General Hospital, Taichung"},{"name":"Office of Medical Administration, Taichung 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