Chest
Volume 128, Issue 3, September 2005, Pages 1650-1656
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Clinical Investigations in Critical Care
Impact of Ventilator-Associated Pneumonia on Outcome in Patients With COPD

https://doi.org/10.1378/chest.128.3.1650Get rights and content

Purpose

The aim of this study was to determine the impact of ventilator-associated pneumonia (VAP) on outcome in patients with COPD.

Methods

Prospective, observational, case-control study conducted in a 30-bed ICU during a 5-year period. All COPD patients who required intubation and mechanical ventilation (MV) for > 48 h were eligible. VAP diagnosis was based on clinical, radiographic, and quantitative microbiologic criteria. Patients with unconfirmed VAP were excluded, as well as patients with ventilator-associated tracheobronchitis without subsequent VAP. Matching (1:1) criteria included MV duration before VAP occurrence, age ± 5 years, simplified acute physiology score II on ICU admission ± 5, and ICU admission category. Variables associated with ICU mortality were determined using univariate and multivariate analyses.

Results

A total of 1,241 patients were eligible; 181 patients (14%) were excluded, including 133 patients for VAT and 48 patients for unconfirmed VAP. VAP developed in 77 patients (6%), and all were successfully matched. Pseudomonas aeruginosa was the most frequently isolated bacteria (31%). ICU mortality rate (64% vs 28%), duration of MV (24 ± 15 d vs 13 ± 11 d [± SD]), and ICU stay (26 ± 17 d vs 15 ± 13 d) were significantly (< 0.001) higher in case patients than in control patients. VAP was the only variable independently associated with ICU mortality (odds ratio [OR], 7.7; 95% confidence interval [CI], 3.2 to 18.6; p < 0.001). In VAP patients who received corticosteroids during their ICU stay compared with those who did not receive corticosteroids, mortality rate (50% vs 82%; OR, 1.8; 95% CI, 1.2 to 2.7; p = 0.002), duration of MV (21 ± 14 d vs 27 ± 16 d, p = 0.043), and ICU stay (22 ± 16 d vs 31 ± 18 d, p = 0.006) were significantly lower.

Conclusion

VAP is associated with increased mortality rates and longer duration of MV and ICU stay in COPD patients.

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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    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).

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