The relationship between ventilator-associated pneumonia and chronic obstructive pulmonary disease: what is the current evidence?

Abstract

Chronic obstructive pulmonary disease (COPD) affects approximately 65 million people from which > 25% will require intensive care unit (ICU) admission. Ventilator-associated pneumonia (VAP) is the commonest ICU infection and results in increased morbidity/mortality and costs. The literature on the interaction between COPD and VAP is scarce and controversial. The project aimed to search the literature in order to address the following: (i) Is COPD a risk factor for VAP development? (ii) Does COPD impact the outcome of patients with VAP? (iii) Does VAP development impact the outcome of COPD patients? (iv) Does COPD impact the aetiology of VAP? Current evidence on the topic is controversial. Regarding the impact of VAP on COPD patients, the majority of the existing limited number of studies suggests that VAP development results in higher mortality and longer duration of mechanical ventilation and ICU stay. Also, the majority of the studies exploring the impact of COPD on VAP outcomes suggest that COPD is independently associated with a decrease in survival, although the number of such studies is limited. Regarding the aetiology, Pseudomonas aeruginosa is the most frequent pathogen in VAP patients with COPD. Noteworthy, one study suggests that P. aeruginosa is higher in COPD patients even in the early-onset VAP subgroup. This manuscript provides a comprehensive overview of the available literature on the interaction between COPD and VAP, highlighting the differences and limitations that may have led to controversial results, and it may act as a platform for further research with important clinical implications.

Ventilator-associated pneumonia in patients on prolonged mechanical ventilation: description, risk factors for mortality, and performance of the SOFA score

“…COPD is an independent factor associated with increased mortality, longer length of MV, longer length of ICU stay, and higher rates of infection with P. aeruginosa in patients with VAP. 37 - 40 Our results are in line with the results in those studies with patients on acute MV. 37 - 40 However, we found no association between COPD and 30-day mortality, even though there was a trend toward that (p = 0.06).…”

“… 37 - 40 Our results are in line with the results in those studies with patients on acute MV. 37 - 40 However, we found no association between COPD and 30-day mortality, even though there was a trend toward that (p = 0.06). This could be due to the small number of patients in our study, but it might also reflect a greater effect of COPD on 90-day mortality.…”

“…A DPOC é um fator independente associado a maior mortalidade, maior duração da VM, maior tempo de permanência na UTI e maiores taxas de infecção por P. aeruginosa em pacientes com PAVM. (37)(38)(39)(40) Nossos resultados vão ao encontro dos resultados desses estudos com pacientes em VM aguda. (37)(38)(39)(40) Entretanto, não encontramos nenhuma associação entre DPOC e mortalidade em 30 dias, mesmo tendo havido uma tendência nesse sentido (p = 0,06).…”

“…(37)(38)(39)(40) Nossos resultados vão ao encontro dos resultados desses estudos com pacientes em VM aguda. (37)(38)(39)(40) Entretanto, não encontramos nenhuma associação entre DPOC e mortalidade em 30 dias, mesmo tendo havido uma tendência nesse sentido (p = 0,06). Isso pode ser devido ao pequeno número de pacientes em nosso estudo, mas também pode refletir um efeito maior da DPOC sobre a mortalidade em 90 dias.…”

Effect of chronic obstructive pulmonary disease combined with ventilator‑associated pneumonia on patient outcomes: A systematic review and meta‑analysis

“…The inter-relation between COPD and VAP, however, has not been thoroughly analyzed in the literature. In a narrative review, Koulenti et al (7) assessed the current literature on the effects of VAP on patients with COPD and vice versa. To the best of our knowledge, to date, no meta-analysis has analyzed outcomes of patients with COPD and VAP.…”