Opioid Use and Ventilator-Associated Pneumonia

Makris, Demosthènes; Lubret, Rémy; Nseir, Saad

doi:10.2174/157339810790820449

Cited by 4 publications

(8 citation statements)

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“…Other risk factors for aspiration in intubated patients include underinflation of tracheal cuff (<20 cmH 2 O), sedation, and nature of tracheal cuff [28]. Cuff underinflation is common in intubated critically ill patients, and was identified as an independent risk factor for VAP [29].…”

Section: Different Routes For Lrtcmentioning

confidence: 99%

Pathophysiology of Airway Colonization in Critically ill COPD Patient

Nseir¹,

Ader²,

Lubret³

et al. 2011

CDT

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Although noninvasive ventilation (NIV) use in severe acute exacerbation of COPD has substantially reduced the need for intubation, an important number of COPD patients still are mechanically ventilated through a tracheal tube in the ICU. Intubation is a major risk factor for lower respiratory tract colonization (LRTC) in ICU patients. Other risk factors for LRTC include colonization of the oral cavity, nasopharynx, and gastric content. Aspiration of contaminated oropharyngeal secretions is increased by supine position, underinflation of tracheal cuff, coma, and sedation. Tracheal tube biofilm formation plays an important role as a reservoir for microorganisms. Reduced cough reflex, altered mucocilliary clearance, hypersecretion and retention of mucus are frequent in COPD patients. In addition, malnutrition and corticosteroid use are common in this population resulting in altered cellular, and humoral immunity and higher risk for LRTC. Incidence of LRTC varies from 22-95% of intubated patients. Pseudomonas aeruginosa is the most frequently isolated microorganism at day 3 after intubation in COPD patients. LRTC is a major risk factor for ventilator-associated pneumonia, which is associated with increased mortality and morbidity in ICU patients. Several measures could be suggested to reduce LRTC in critically ill COPD patients. NIV use in severe acute exacerbations reduces the need for intubation. In addition, the early use of NIV averts respiratory failure after extubation and could reduce the duration of invasive mechanical ventilation. Other measures might be efficient in preventing LRTC such as semirecumbent position, avoidance of gastric distension, polyurethane-cuffed tracheal tubes, silver-coated tracheal tubes, subglottic aspiration, and continuous control of cuff pressure. Further studies should determine the impact of preventive measures aiming at preventing LRTC on outcome of COPD patients requiring intubation and mechanical ventilation in the ICU.

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Section: Different Routes For Lrtcmentioning

confidence: 99%

Pathophysiology of Airway Colonization in Critically ill COPD Patient

Nseir¹,

Ader²,

Lubret³

et al. 2011

CDT

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“…Translocation of bacteria and endotoxins can lead to infections and enhanced systemic inflammation. 50,55 Again, the precise role of opioids in this is yet to be delineated.…”

Section: Short-term Adverse Effects Of Opioids In the Intensive Care ...mentioning

confidence: 99%

“…There is a substantial body of literature detailing the effects of opioids on both the innate and adaptive immune system. 49,50,[52][53][54][55] Opioids may affect immune function with acute exposure, chronic exposure or during acute opioid withdrawal.…”

Section: Intensive Care Unit-acquired Infectionmentioning

confidence: 99%

The complications of opioid use during and post–intensive care admission: A narrative review

Moran

Myburgh

Scott

2022

Anaesth Intensive Care

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Opioids are a commonly administered analgesic medication in the intensive care unit, primarily to facilitate invasive mechanical ventilation. Consensus guidelines advocate for an opioid-first strategy for the management of acute pain in ventilated patients. As a result, these patients are potentially exposed to high opioid doses for prolonged periods, increasing the risk of adverse effects. Adverse effects relevant to these critically ill patients include delirium, intensive care unit–acquired infections, acute opioid tolerance, iatrogenic withdrawal syndrome, opioid-induced hyperalgesia, persistent opioid use, and chronic post–intensive care unit pain. Consequently, there is a challenge of optimising analgesia while minimising these adverse effects. This narrative review will discuss the characteristics of opioid use in the intensive care unit, outline the potential short-term and long-term adverse effects of opioid therapy in critically ill patients, and outline a multifaceted strategy for opioid minimisation.

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“…23,24 However, despite these arguments, there is considerable controversy over the specific indications and optimum timing of tracheostomy that could be useful for reducing VAP incidence. First, although many seem to agree that patients who were anticipated to need prolonged mechanical ventilation should be tracheostomized as early as possible, 10,11,14,25 the anticipation of long mechanical ventilation remains largely subjective.…”

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confidence: 99%

Tracheostomy in Ventilator-associated Pneumonia

Makris¹,

Nseir²

2011

Clinical Pulmonary Medicine

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Tracheostomy is considered as a strategy that may improve respiratory mechanics and patient comfort and help in the management of secretions and weaning. Tracheostomy has also been suggested as a measure to decrease the risk of development of ventilator-associated pneumonia (VAP), compared with translaryngeal intubation. However, it has not been established whether tracheostomy is an effective strategy for VAP prevention. Data from observational and randomized trials found conflicting results on the relationship between tracheostomy and VAP. A recent large randomized, multicenter, well-designed and conducted study failed to demonstrate a significant reduction in VAP rate in patients who received early compared with late tracheostomy. Physicians' attitudes regarding tracheostomy may be heterogeneous across different intensive care units and the decision to perform tracheostomy is still challenging. In the present article, we therefore aimed to determine the relationship between VAP and tracheostomy, and whether available data suggest that tracheostomy can prevent the occurrence of VAP.

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Opioid Use and Ventilator-Associated Pneumonia

Cited by 4 publications

References 0 publications

Pathophysiology of Airway Colonization in Critically ill COPD Patient

Pathophysiology of Airway Colonization in Critically ill COPD Patient

The complications of opioid use during and post–intensive care admission: A narrative review

Tracheostomy in Ventilator-associated Pneumonia

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