Ventilator-associated pneumonia and chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is a common pulmonary and systemic inflammatory disease. Patients with COPD frequently require mechanical ventilation for acute exacerbations.
The incidence of ventilator-associated pneumonia (VAP) in COPD patients varies from 6 to 33%. Tracheo-bronchial colonisation, local and systemic immuno-supression and frequent antibiotic treatment are factors predisposing to VAP in these patients. Gram negative bacilli are commonly isolated in COPD patients with VAP. Pseudomonas aeruginosa reported to be the most common. The diagnosis of VAP can be difficult in patients with COPD because of the low sensitivity of the portable chest radiograph. VAP is associated with higher mortality rates, longer duration of mechanical ventilation and ITU stay in patients with COPD. Initial antibiotic treatment should be based on recent guidelines and should take account of frequent prior hospitalisation and antibiotic treatment which are well known risk factors for multidrug resistant bacteria. Preventative measures recommended for the general population should be applied to COPD patients. In the absence of contraindications the use of non-invasive ventilation is recommended to reduce the risk of VAP.
Viewpoint and conclusion
Future studies should better determine the incidence of VAP in COPD, improve the diagnostic approach and determine the effects of treating malnutrition, chronic tracheobronchial colonisation and limiting antibiotic and corticosteroid treatment on the incidence of VAP.
Ventilator associated pneumonia
Chronic obstructive pulmonary disease
© 2007 Elsevier Masson SAS. Tous droits réservés.