Chronic obstructive pulmonary disease and the risk for ventilator-associated pneumonia

Abstract

COPD is a risk factor for VAP. Future studies should focus on specific preventive measures in this population.

Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: A retrospective study

“…Patients with severe ARF are usually managed with intubation and invasive mechanical ventilation (MV), but their clinical course is frequently complicated by ventilator associated pneumonia (VAP) [2]. The risk of VAP is particularly high in patients with malignancies, immunocompromise and chronic obstructive pulmonary disease (COPD) [3][4][5][6].…”

Chronic Obstructive Pulmonary Disease and Ventilator-Associated Pneumonia

“…8 The Centers for Disease Control and Prevention defines the criteria for developing VAP as a patient who is on mechanical ventilation for more than 2 calendar days with the day of ventilator placement being day 1 and the ventilator being in place on the date or the day before. 6 According to a cohort study of mechanically ventilated patients conducted in Austria, 10% of critically ill patients received mechanical ventilation because of an acute exacerbation of COPD in the year 1998, and 6% in 2010.…”

“…8 Makris et al 3 defined multidrug-resistant bacteria in VAP as methicillin-resistant Staphylococcus aureus, ceftazidime-or imipenem-resistant P aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia, and extendedspectrum "-lactamaseYproducing gram-negative bacilli. One of the largest studies on VAP in COPD patients found that P aeruginosa is responsible for 31% of VAP episodes, trailed by A baumannii at 19% and S aureus reaching 13%.…”

“…16 Looking for further causes, one must consider nebulizer treatments, altered host defense mechanisms with impaired defenses against colonization, and immunosuppression as contributing factors to the development of VAP in COPD. 8 Manipulation of respiratory equipment during nebulization or suctioning can cause the lower airways to be directly colonized. 17 Nebulizing treatments are frequently used in COPD patients who are mechanically ventilated (many times per day in some instances) and are known as a risk factor for VAP as a recent cohort study of 439 patients found (OR, 1.52; 95% CI, 1.06-2.19; P = .021).…”

“…19,20 The chronic inflammation present with COPD prevents this mucus trapping from occurring because of the damaged ciliated epithelium. 8 Once the goblet cells begin to overproduce mucus, distal airway occlusion and a feeble cough secondary to respiratory muscle malfunction and reduced peak expiratory flow cause the mucus clearance mechanism to be ineffective. 20 Host defense mechanisms in COPD patients are known to be inadequate in comparison with a healthy individual.…”