Tients admitted in the ICU for ARDS according to the Berlin definition criteria (within 48 h of admission) and receiving invasive mechanical ventilation more than a 10-year period (January 2006 to December 2015) have been incorporated [12]. Exclusion criteria had been as follows: previously identified lung interstitial illness or tumoral infiltration, chronic respiratory failure requiring long-term oxygen therapy, pure cardiogenic pulmonary edema, mild ARDS treated with noninvasive ventilation only, proven or suspected invasive pulmonary aspergillosis under antifungal therapy upon ARDS diagnosis and patients for whom no endobronchial sampling had been obtained. All respiratory tract samples (plugged telescoping catheter, tracheal aspirate or bronchoalveolar fluid) performed for microbiological examination have been analyzed. Galactomannan antigen (GM) detection in plasma and in bronchoalveolar lavage (BAL) fluid was performed at the discretion with the managing doctor. An opticalPatients were categorized into two groups: these with one or a lot more respiratory tract sample constructive in culture for Aspergillus spp. (Aspergillus+ patients) during the ICU remain and these with out such constructive sample (Aspergillus- individuals). The former group was further split into 3 categories based on the probability of IPA according to the clinical algorithm proposed by Blot et al. [16]: (A) established IPA (microscopic analysis on sterile material: histopathologic, cytopathologic or PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/21301260 direct microscopic examination of a specimen obtained by needle aspiration or sterile biopsy in which hyphae are observed accompanied by proof of related tissue harm; isolation of Aspergillus from culture of a specimen obtained by lung biopsy); (B) putative IPA in case of (1) Aspergillus-positive lower respiratory tract specimen culture (entry criterion) with (2) compatible signs and symptoms (one of the following: fever refractory to at the least 3 days of proper antibiotic therapy, recrudescent fever right after a period of defervescence of at the very least 48 h even though nevertheless on antibiotics and with out other apparent lead to, pleuritic chest pain, pleuritic rub, dyspnea, hemoptysis, worsening respiratory insufficiency in spite of proper antibiotic therapy and ventilatory support) and (three) abnormal healthcare imaging by transportable chest X-ray or CT scan from the lungs, and either (4a) a host danger element (among the following circumstances: neutropenia (absolute MedChemExpress ML-128 neutrophil count 500 GL) preceding or at the time of ICU admission, underlying hematological or oncological malignancy treated with cytotoxic agents, glucocorticoid therapy (prednisone equivalent 20 mgday), congenital or acquired immunodeficiency) or (4b) a semiquantitative Aspergillus-positive culture of BAL fluid (+ or +++), without having bacterial growth with each other using a positive cytological smear showing branching hyphae or (C) Aspergillus respiratory tract colonization when 1 criterion important for a diagnosis of putative IPA was not met (Tables 1, 2).Collection of data and definitionsDemographics and clinical traits upon ICU admission and in the course of ICU stay have been abstracted from the health-related charts of all individuals. Immunosuppression was defined by one of the following conditions: neutropenia (absolute neutrophil count 500 GL) preceding or in the time of ICU admission, underlying hematological or oncological malignancy treated with cytotoxic agents, glucocorticoid treatment (prednisone equivalent 20 mgContou et al. Ann. Intensive Care (2016) 6:Web page three ofTable.
