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Clinical Investigations in Critical Care |

Impact of Ventilator-Associated Pneumonia on Outcome in Patients With COPD*

Saad Nseir, MD; Christophe Di Pompeo, PhD; Stéphane Soubrier, MD; Béatrice Cavestri, MD; Elsa Jozefowicz, MD; Fabienne Saulnier, MD; Alain Durocher, MD
Author and Funding Information

*From the Intensive Care Unit (Drs. Nseir, Soubrier, Cavestri, Jozefowicz, Saulnier, and Durocher), Calmette Hospital, Regional University Centre; and Medical Assessment Laboratory (Dr. Di Pompeo), EA 3614, Lille II University, Lille, France.

Correspondence to: Saad Nseir, MD, Réanimation Médicale, Hôpital Calmette, CHRU, boulevard du Pr Leclercq, 59037 Lille cedex, France; e-mail s-nseir@chru-lille.fr



Chest. 2005;128(3):1650-1656. doi:10.1378/chest.128.3.1650
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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.

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