Study Comparing Inhaled Amikacin Versus Placebo to Prevent Ventilator Associated Pneumonia

Double-blinded Multicenter Randomized Controlled Trial Comparing Inhaled Amikacin Versus Placebo to Prevent Ventilator Associated Pneumonia

The objective of the study is to prove that after the third day of invasive mechanical ventilation a three-day course of inhaled amikacin reduces the incidence of subsequent VAP.

Parallel two group double blind randomized controlled clinical trial. Individual randomization, performed on day 4 of invasive mechanical ventilation, will be stratified on centre in order to account for variations in VAP prevention bundle implementation and use of systemic antibiotics the day of randomization. Patients will be treated three consecutive days with inhaled amikacin or placebo. Patients will be followed up daily in the intensive care unit for the occurrence of VAP according to international guidelines until day 28.

Inclusion Criteria:

• Age ≥ 18 years the day of inclusion
• Mechanical ventilation through an endotracheal tube for more than three consecutive days (72h)
• Written informed consent of the patient or a proxy
• Patients covered by or having the rights to French social security
• Negative pregnancy test, at the time of inclusion, in women of childbearing potential

Exclusion Criteria:

• Suspicion or confirmed VAP the day of inclusion
• Clinical indication for systemic aminoglycoside therapy the day of inclusion : as deemed necessary by the clinician in charge
• Stage 2 or 3 KDIGO* classification acute kidney injury the day of inclusion excepted in patients undergoing renal replacement therapy
• Chronic kidney failure : baseline glomerular filtration lower than 30 mL/min
• Patient scheduled for extubation within the next 24h
• Patient ventilated through an endotracheal tube for more than four consecutive days before inclusion (96h)
• Patient ventilated through a tracheostomy
• Patients allergic to aminoglycosides
• Myasthenia gravis
• Known pregnant women at the time of inclusion and lactating patients
• Known guardianship or trusteeship at the time of inclusion
• Patients previously included in this study