Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohort.

Autor: Galerneau LM; Medical Intensive Care Unit, University Hospital of Grenoble Alpes, 10217 38043, Grenoble, CS, France. lmgalerneau@chu-grenoble.fr.; Grenoble Alpes University, INSERM 1300, HP2, Grenoble, France. lmgalerneau@chu-grenoble.fr., Bailly S; Grenoble Alpes University, INSERM 1300, HP2, Grenoble, France., Terzi N; Medical Intensive Care Unit, University Hospital of Grenoble Alpes, 10217 38043, Grenoble, CS, France.; Grenoble Alpes University, INSERM 1300, HP2, Grenoble, France., Ruckly S; Department of Biostatistics, Outcomerea, Paris, France., Garrouste-Orgeas M; Medical Unit, French and British Hospital Cognacq-Jay Fondation, Levallois-Perret, France., Oziel J; Intensive Care Unit, Avicenne Hospital, AP-HP, Paris, France., Hong Tuan Ha V; Medical Intensive Care Unit, Meaux Hospital, Meaux, France., Gainnier M; Medical Intensive Care Unit, La Timone Hospital, Marseille, France., Siami S; Critical Care Medicine Unit, Etampes-Dourdan Hospital, Etampes, France., Dupuis C; Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France., Forel JM; Medical Intensive Care Unit, Nord University Hospital, Marseille, France., Dartevel A; Medical Intensive Care Unit, University Hospital of Grenoble Alpes, 10217 38043, Grenoble, CS, France., Dessajan J; Medical and Infectious Diseases Intensive Care Unit (MI2), Bichat Hospital, AP-HP, Paris, France., Adrie C; Polyvalent Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France., Goldgran-Toledano D; Medical Intensive Care Unit, Le Raincy-Montfermeil Hospital, Montfermeil, France., Laurent V; Intensive Care Unit, André Mignot Hospital, Le Chesnay, France., Argaud L; Medical Intensive Care Unit, Edouard Herriot Hospital, Lyon Civil Hospices, Lyon, France., Reignier J; Medical Intensive Care Unit, Nantes University Hospital, Nantes, France., Pepin JL; Grenoble Alpes University, INSERM 1300, HP2, Grenoble, France., Darmon M; Intensive Care Unit, Saint-Louis Hospital, AP-HP, Paris, France., Timsit JF; Medical and Infectious Diseases Intensive Care Unit (MI2), Bichat Hospital, AP-HP, Paris, France.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2023 Sep 19; Vol. 27 (1), pp. 359. Date of Electronic Publication: 2023 Sep 19.
DOI: 10.1186/s13054-023-04631-2
Abstrakt: Background: Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP), a nosocomial pneumonia that is not related to invasive mechanical ventilation (IMV), has been less studied than ventilator-associated pneumonia, and never in the context of patients in an ICU for severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD), a common cause of ICU admission. This study aimed to determine the factors associated with NV-ICU-AP occurrence and assess the association between NV-ICU-AP and the outcomes of these patients.
Methods: Data were extracted from the French ICU database, OutcomeRea™. Using survival analyses with competing risk management, we sought the factors associated with the occurrence of NV-ICU-AP. Then we assessed the association between NV-ICU-AP and mortality, intubation rates, and length of stay in the ICU.
Results: Of the 844 COPD exacerbations managed in ICUs without immediate IMV, NV-ICU-AP occurred in 42 patients (5%) with an incidence density of 10.8 per 1,000 patient-days. In multivariate analysis, prescription of antibiotics at ICU admission (sHR, 0.45 [0.23; 0.86], p = 0.02) and no decrease in consciousness (sHR, 0.35 [0.16; 0.76]; p < 0.01) were associated with a lower risk of NV-ICU-AP. After adjusting for confounders, NV-ICU-AP was associated with increased 28-day mortality (HR = 3.03 [1.36; 6.73]; p < 0.01), an increased risk of intubation (csHR, 5.00 [2.54; 9.85]; p < 0.01) and with a 10-day increase in ICU length of stay (p < 0.01).
Conclusion: We found that NV-ICU-AP incidence reached 10.8/1000 patient-days and was associated with increased risks of intubation, 28-day mortality, and longer stay for patients admitted with AECOPD.
(© 2023. BioMed Central Ltd., part of Springer Nature.)
Databáze: MEDLINE
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