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Published on: January 29, 2011
Is COPD associated with increased risk for microaspiration in intubated critically ill patients?
Thècle Degroote1, Emmanuelle Jaillette2, Jean Reignier3,4
1Service de Médecine Intensive et Réanimation, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
Background:
Although 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.
Methods:
This 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.
Results:
Among 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.
Conclusions:
Our results suggest that COPD is not associated with increased risk for abundant microaspiration in intubated critically ill patients.
Insights
Chronic obstructive pulmonary disease (COPD) patients do not face a higher risk of microaspiration when invasively ventilated. This study found no significant difference in microaspiration rates between COPD and non-COPD patients in the ICU.
Area of Science:
- Critical Care Medicine
- Pulmonary Medicine
- Gastroenterology
Background:
- Patients with Chronic Obstructive Pulmonary Disease (COPD) have an elevated risk of aspiration during spontaneous breathing.
- Limited data exists regarding the risk of microaspiration in invasively ventilated COPD patients.
Purpose of the Study:
- To investigate the association between COPD and abundant microaspiration in critically ill patients requiring invasive mechanical ventilation.
- To determine if COPD status influences the rate of microaspiration in intubated patients.
Main Methods:
- Retrospective analysis of prospectively collected data from three randomized controlled trials.
- Invasive mechanical ventilation for over 48 hours was a criterion for inclusion.
- Abundant microaspiration was defined by significant levels of pepsin and/or alpha-amylase in tracheal aspirates, quantitatively measured over 48 hours. COPD was diagnosed via spirometry.
Main Results:
- Of 515 patients, 70 (14%) had COPD. The rate of abundant microaspiration was similar between COPD (89%) and non-COPD (82%) patients (p=0.25).
- No significant differences were observed in microaspiration of gastric contents (53% vs 45%), oropharyngeal secretions (71% vs 71%), or ventilator-associated pneumonia (VAP) rates (19% vs 22%) between groups.
- Duration of mechanical ventilation, ICU length of stay, and ICU mortality did not differ significantly between COPD and non-COPD patients.
Conclusions:
- COPD is not associated with an increased risk of abundant microaspiration in intubated, critically ill patients.
- Findings suggest that current ventilation strategies may mitigate aspiration risks in COPD patients.
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