Chest
Clinical Investigations in Critical CareImpact of Ventilator-Associated Pneumonia on Outcome in Patients With COPD
Section snippets
Materials and Methods
This prospective, observational, case-control study was conducted in a 30-bed ICU from January 1996 to January 2001. Because it was observational, Institutional Review Board approval was not required in accordance with Institutional Review Board Regulation.
All COPD patients who required intubation and MV for > 48 h were eligible. Patients without COPD, trauma patients, patients who did not receive MV or received MV for < 48 h, patients who only received noninvasive ventilation (NIV), patients
Results
During the study period, 1,241 patients were eligible; 181 patients (14%) were excluded, including 133 patients (10%) for VAT without subsequent VAP, and 48 patients (3%) for clinically suspected VAP without bacteriologic confirmation. VAP developed in 77 patients (6%), and were all successfully matched (Fig 1). The rate of prior antibiotic use was higher in case patients than in control patients. During ICU stay, the duration of antibiotic treatment was longer in case patients than in control
Discussion
Our results demonstrate that VAP is associated with higher mortality rates and longer duration of MV and ICU stay in COPD patients. In addition, VAP is independently associated with ICU mortality. Our results also suggest that low doses of corticosteroids are associated with a lower mortality rate and shorter duration of MV and ICU stay in COPD patients with VAP.
To our knowledge, this case-control study is the first to evaluate the impact of VAP on mortality and morbidity in COPD patients.
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Cited by (97)
Ventilator-Associated Tracheobronchitis
2021, Encyclopedia of Respiratory Medicine, Second EditionHospital admissions for community-acquired, ventilator-associated and nonventilator hospital-acquired pneumonia in COPD patients in Spain (2016-2017).
2020, European Journal of Internal MedicineHow Can We Distinguish Ventilator-Associated Tracheobronchitis from Pneumonia?
2018, Clinics in Chest MedicineCitation Excerpt :VAT has been shown to prolong the duration of invasive mechanical ventilation, increase the length of ICU stay, and predispose the patient to subsequent episodes of VAP, without an increase in mortality, when compared with intubated mechanically ventilated patients without VAT.9,11,20,23 In contrast, VAP is a well-recognized independent risk factor for increased mortality24,25 and carries a higher mortality rate than VAT.26 This makes it a challenging proposition to merge VAT and VAP as the unified clinical entity, ventilator-associated lower respiratory infections (VA-LRTIs),22 and physicians must acknowledge them as separate conditions.
Hospital-acquired pneumonia in ICU
2018, Anaesthesia Critical Care and Pain Medicine
Presented in part at the 101st American Thoracic Society Conference, May 20–25, 2005, San Diego, CA.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).