Abstract
BackgroundAlthough COPD patients are at higher risk for aspiration when breathing spontaneously, no information is available on the risk for microaspiration in invasively ventilated COPD patients. The aim of our study was to determine the relationship between COPD and abundant microaspiration in intubated critically ill patients.MethodsThis was a retrospective analysis of prospectively collected data, provided by 3 randomized controlled trials on microaspiration in critically ill patients receiving invasive mechanical ventilation for more than 48 h. Abundant microaspiration was defined as the presence of pepsin and or alpha-amylase at significant levels in tracheal aspirates. In all study patients, pepsin and alpha-amylase were quantitatively measured in all tracheal aspirates collected during a 48-h period. COPD was defined using spirometry criteria.ResultsAmong the 515 included patients, 70 (14%) had proven COPD. Pepsin and alpha-amylase were quantitatively measured in 3873 and 3764 tracheal aspirates, respectively. No significant difference was found in abundant microaspiration rate between COPD and non-COPD patients (62 of 70 patients (89%) vs 366 of 445 (82%) patients, p = 0.25). Similarly, no significant difference was found in abundant microaspiration of gastric contents (53% vs 45%, p = 0.28), oropharyngeal secretions (71% vs 71%, p = 0.99), or VAP (19% vs 22%, p = 0.65) rates between the two groups. No significant difference was found between COPD and non-COPD patients in duration of mechanical ventilation, ICU length of stay, or ICU mortality.ConclusionsOur results suggest that COPD is not associated with increased risk for abundant microaspiration in intubated critically ill patients.
Highlights
chronic obstructive pulmonary disease (COPD) patients are at higher risk for aspiration when breathing spontaneously, no informa‐ tion is available on the risk for microaspiration in invasively ventilated COPD patients
Eighty-four (14%) patients were excluded, including 59 (10%) because no tracheal aspirate was available for measurement of pepsin or alpha-amylase and 25 (4%) because spirometry was not available to confirm COPD diagnosis
Patient characteristics At Intensive care unit (ICU) admission, several significant differences were found between COPD and non-COPD patients (Table 1)
Summary
COPD patients are at higher risk for aspiration when breathing spontaneously, no informa‐ tion is available on the risk for microaspiration in invasively ventilated COPD patients. Ventilator-associated pneumonia (VAP) is a common ICU-acquired infection in patients requiring intubation and mechanical ventilation [1, 2]. This infection is associated with increased morbidity, mortality, and cost [3,4,5,6]. Based on the results of the largest international epidemiological study on mechanical ventilation, the proportion of COPD in patients receiving invasive mechanical ventilation slightly decreased from 10% in 1998 to 7% in 2016 [16]. Another recent large international study reported that COPD patients represented 22% of patients receiving mechanical ventilation for acute respiratory distress syndrome (ARDS) in the ICU [17]
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