Anahita Rouzé1, Aurélie Cottereau, Saad Nseir. 1. aCritical Care Department, R. Salengro Hospital, CHRU, Lille bEA 2694, Université Nord de France, Lille, France.
Abstract
PURPOSE OF REVIEW: To discuss recent data on the relationship between chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP). RECENT FINDINGS: Despite increased use of noninvasive ventilation, a large proportion of COPD patients still require invasive mechanical ventilation. Intubated COPD patients are at increased risk for VAP compared with patients without COPD. VAP is associated with increased mortality and duration of mechanical ventilation in these patients. Specific risk factors for VAP in this population include prolonged duration of invasive mechanical ventilation, high incidence of microaspiration and bacterial colonization, and altered local and general host defense mechanisms. Skeletal and diaphragmatic muscle weakness resulting from malnutrition, inflammation, and systemic corticosteroids is the main cause for prolonged mechanical ventilation. Increased risk for microaspiration of contaminated secretions is related to gastro-esophageal reflux, and altered interaction between breathing and deglutition. Defective mucociliary clearance contributes to a high incidence of respiratory tract colonization in these patients. Further, increasing evidence suggests that COPD is associated with immunosuppression promoting pulmonary infection. SUMMARY: COPD is a risk factor for VAP. Future studies should focus on specific preventive measures in this population.
PURPOSE OF REVIEW: To discuss recent data on the relationship between chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP). RECENT FINDINGS: Despite increased use of noninvasive ventilation, a large proportion of COPDpatients still require invasive mechanical ventilation. Intubated COPDpatients are at increased risk for VAP compared with patients without COPD. VAP is associated with increased mortality and duration of mechanical ventilation in these patients. Specific risk factors for VAP in this population include prolonged duration of invasive mechanical ventilation, high incidence of microaspiration and bacterial colonization, and altered local and general host defense mechanisms. Skeletal and diaphragmatic muscle weakness resulting from malnutrition, inflammation, and systemic corticosteroids is the main cause for prolonged mechanical ventilation. Increased risk for microaspiration of contaminated secretions is related to gastro-esophageal reflux, and altered interaction between breathing and deglutition. Defective mucociliary clearance contributes to a high incidence of respiratory tract colonization in these patients. Further, increasing evidence suggests that COPD is associated with immunosuppression promoting pulmonary infection. SUMMARY:COPD is a risk factor for VAP. Future studies should focus on specific preventive measures in this population.
Authors: Simone Lindau; Manuel Nadermann; Hanns Ackermann; Tobias Michael Bingold; Christoph Stephan; Volkhard A J Kempf; Pia Herzberger; Andres Beiras-Fernandez; Kai Zacharowski; Patrick Meybohm Journal: J Intensive Care Date: 2015-07-03
Authors: Tjallie I I van der Kooi; Hendriek Boshuizen; Jan C Wille; Sabine C de Greeff; Jaap T van Dissel; Annelot F Schoffelen; Rolina D van Gaalen Journal: PLoS One Date: 2019-06-20 Impact factor: 3.240