Thècle Degroote1, Emmanuelle Jaillette2, Jean Reignier3,4, Farid Zerimech5, Christophe Girault6, Guillaume Brunin7, Arnaud Chiche8, Jean-Claude Lacherade9, Jean-Paul Mira10, Patrice Maboudou5, Malika Balduyck5, Saad Nseir11,12. 1. Service de Médecine Intensive et Réanimation, Groupe Hospitalier Paris Saint-Joseph, Paris, France. 2. Critical Care Center, CHU Lille, 59000, Lille, France. 3. Medecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France. 4. Université de Nantes, Nantes, France. 5. Centre de Biologie Et de Pathologie, CHU Lille, 59000, Lille, France. 6. Normandie Univ, UNIROUEN, EA 3830, Rouen University Hospital, Medical Intensive Care Unit, 76000, Rouen, France. 7. Intensive Care Unit, Boulogne Sur Mer Hospital, Boulogne-sur-Mer, France. 8. Intensive Care Unit, Tourcoing Hospital, Tourcoing, France. 9. Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de La Vendée, La Roche sur Yon, France. 10. Groupe Hospitalier Paris Centre-Université de Paris, Cochin University Hospital, Medical Intensive Care Unit, Paris, France. 11. Critical Care Center, CHU Lille, 59000, Lille, France. s-nseir@chru-lille.fr. 12. INSERM U995, Lille Inflammation Research International Center E2, Lille University, Lille, France. s-nseir@chru-lille.fr.
Abstract
BACKGROUND: Although COPD patients are at higher risk for aspiration when breathing spontaneously, no information is available on the risk for microaspiration in invasively ventilated COPD patients. The aim of our study was to determine the relationship between COPD and abundant microaspiration in intubated critically ill patients. METHODS: This was a retrospective analysis of prospectively collected data, provided by 3 randomized controlled trials on microaspiration in critically ill patients receiving invasive mechanical ventilation for more than 48 h. Abundant microaspiration was defined as the presence of pepsin and or alpha-amylase at significant levels in tracheal aspirates. In all study patients, pepsin and alpha-amylase were quantitatively measured in all tracheal aspirates collected during a 48-h period. COPD was defined using spirometry criteria. RESULTS: Among the 515 included patients, 70 (14%) had proven COPD. Pepsin and alpha-amylase were quantitatively measured in 3873 and 3764 tracheal aspirates, respectively. No significant difference was found in abundant microaspiration rate between COPD and non-COPD patients (62 of 70 patients (89%) vs 366 of 445 (82%) patients, p = 0.25). Similarly, no significant difference was found in abundant microaspiration of gastric contents (53% vs 45%, p = 0.28), oropharyngeal secretions (71% vs 71%, p = 0.99), or VAP (19% vs 22%, p = 0.65) rates between the two groups. No significant difference was found between COPD and non-COPD patients in duration of mechanical ventilation, ICU length of stay, or ICU mortality. CONCLUSIONS: Our results suggest that COPD is not associated with increased risk for abundant microaspiration in intubated critically ill patients.
BACKGROUND: Although COPDpatients are at higher risk for aspiration when breathing spontaneously, no information is available on the risk for microaspiration in invasively ventilated COPDpatients. The aim of our study was to determine the relationship between COPD and abundant microaspiration in intubated critically illpatients. METHODS: This was a retrospective analysis of prospectively collected data, provided by 3 randomized controlled trials on microaspiration in critically illpatients receiving invasive mechanical ventilation for more than 48 h. Abundant microaspiration was defined as the presence of pepsin and or alpha-amylase at significant levels in tracheal aspirates. In all study patients, pepsin and alpha-amylase were quantitatively measured in all tracheal aspirates collected during a 48-h period. COPD was defined using spirometry criteria. RESULTS: Among the 515 included patients, 70 (14%) had proven COPD. Pepsin and alpha-amylase were quantitatively measured in 3873 and 3764 tracheal aspirates, respectively. No significant difference was found in abundant microaspiration rate between COPD and non-COPDpatients (62 of 70 patients (89%) vs 366 of 445 (82%) patients, p = 0.25). Similarly, no significant difference was found in abundant microaspiration of gastric contents (53% vs 45%, p = 0.28), oropharyngeal secretions (71% vs 71%, p = 0.99), or VAP (19% vs 22%, p = 0.65) rates between the two groups. No significant difference was found between COPD and non-COPDpatients in duration of mechanical ventilation, ICU length of stay, or ICU mortality. CONCLUSIONS: Our results suggest that COPD is not associated with increased risk for abundant microaspiration in intubated critically illpatients.
Authors: Wilhelmina G Melsen; Maroeska M Rovers; Rolf H H Groenwold; Dennis C J J Bergmans; Christophe Camus; Torsten T Bauer; Ernst W Hanisch; Bengt Klarin; Mirelle Koeman; Wolfgang A Krueger; Jean-Claude Lacherade; Leonardo Lorente; Ziad A Memish; Lee E Morrow; Giuseppe Nardi; Christianne A van Nieuwenhoven; Grant E O'Keefe; George Nakos; Frank A Scannapieco; Philippe Seguin; Thomas Staudinger; Arzu Topeli; Miquel Ferrer; Marc J M Bonten Journal: Lancet Infect Dis Date: 2013-04-25 Impact factor: 25.071
Authors: Norma A Metheny; Ray E Clouse; Yie-Hwa Chang; Barbara J Stewart; Dana A Oliver; Marin H Kollef Journal: Crit Care Med Date: 2006-04 Impact factor: 7.598