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Trends in use and impact on outcome of empiric antibiotic therapy and non-invasive ventilation in COPD patients with acute exacerbation.

Ouanes I, Ouanes-Besbes L, Ben Abdallah S, Dachraoui F, Abroug F - Ann Intensive Care (2015)

Bottom Line: Whether this practice remains valid to current management with first-line non-invasive ventilation (NIV) is unclear.These figures were associated with a trend toward lower ICU mortality rate (p = 0.058).Logistic regression showed that primary NIV use per se was protective against fatal outcome [odds ratios (OR) = 0.08, 95 %CI 0.03-0.22; p < 0.001], whereas NIV failure, VAP occurrence, and cardiovascular comorbidities were associated with increased ICU mortality [OR = 17.6 (95 %CI 5.29-58.93), 11.5 (95 %CI 5.17-25.45), and 3 (95 %CI 1.37-6.63), respectively].

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Fattouma Bourguiba University Hospital, Rue 1er juin, 5000, Monastir, Tunisia. ouanes.islem@gmail.com.

ABSTRACT

Background: Empiric antibiotic therapy is routinely prescribed in patients with acute COPD exacerbations (AECOPD) requiring ventilatory support on the basis of studies including patients conventionally ventilated. Whether this practice remains valid to current management with first-line non-invasive ventilation (NIV) is unclear.

Methods: In a cohort of ICU patients admitted between 2000 and 2012 for AECOPD, we analyzed the trends in empiric antibiotic therapy and in primary ventilatory support strategy, and their respective impact on patients' outcome.

Results: 440 patients admitted for 552 episodes were included; primary NIV use increased from 29 to 96.7 % (p < 0.001), whereas NIV failure rate decreased significantly (p = 0.004). In parallel, ventilator-associated pneumonia (VAP) rate, VAP density and empiric antibiotic therapy use decreased (p = 0.037, p = 0.002, and p < 0.001, respectively). These figures were associated with a trend toward lower ICU mortality rate (p = 0.058). Logistic regression showed that primary NIV use per se was protective against fatal outcome [odds ratios (OR) = 0.08, 95 %CI 0.03-0.22; p < 0.001], whereas NIV failure, VAP occurrence, and cardiovascular comorbidities were associated with increased ICU mortality [OR = 17.6 (95 %CI 5.29-58.93), 11.5 (95 %CI 5.17-25.45), and 3 (95 %CI 1.37-6.63), respectively]. Empiric antibiotic therapy was associated with decreased VAP rate (log rank; p < 0.001), but had no effect on mortality (log rank; p = 0.793).

Conclusions: The sustained increase in NIV use allowed a decrease in empiric antibiotic prescriptions in AECOPD requiring ventilatory support. Primary NIV use and its success, but not empiric antibiotic therapy, were associated with a favorable impact on patients' outcome.

No MeSH data available.


Related in: MedlinePlus

Study flowchart
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Fig1: Study flowchart

Mentions: During the study period, 961 out of 4425 patients admitted to the ICU had acute on chronic respiratory failure; 409 did not fulfill the definition of COPD exacerbation (principally because of an obvious reversible cause) were not included in the analysis. Of the remaining patients with AECOPD, 440 were admitted 552 times (89 were hospitalized two or more times for AECOPD) and were included in the analysis (Fig. 1). Two-thirds of patients were admitted from the emergency department. Table 1 shows the baseline characteristics of the included patients, and Table 2 reports the variables related to COPD exacerbation episodes.Fig. 1


Trends in use and impact on outcome of empiric antibiotic therapy and non-invasive ventilation in COPD patients with acute exacerbation.

Ouanes I, Ouanes-Besbes L, Ben Abdallah S, Dachraoui F, Abroug F - Ann Intensive Care (2015)

Study flowchart
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4591222&req=5

Fig1: Study flowchart
Mentions: During the study period, 961 out of 4425 patients admitted to the ICU had acute on chronic respiratory failure; 409 did not fulfill the definition of COPD exacerbation (principally because of an obvious reversible cause) were not included in the analysis. Of the remaining patients with AECOPD, 440 were admitted 552 times (89 were hospitalized two or more times for AECOPD) and were included in the analysis (Fig. 1). Two-thirds of patients were admitted from the emergency department. Table 1 shows the baseline characteristics of the included patients, and Table 2 reports the variables related to COPD exacerbation episodes.Fig. 1

Bottom Line: Whether this practice remains valid to current management with first-line non-invasive ventilation (NIV) is unclear.These figures were associated with a trend toward lower ICU mortality rate (p = 0.058).Logistic regression showed that primary NIV use per se was protective against fatal outcome [odds ratios (OR) = 0.08, 95 %CI 0.03-0.22; p < 0.001], whereas NIV failure, VAP occurrence, and cardiovascular comorbidities were associated with increased ICU mortality [OR = 17.6 (95 %CI 5.29-58.93), 11.5 (95 %CI 5.17-25.45), and 3 (95 %CI 1.37-6.63), respectively].

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Fattouma Bourguiba University Hospital, Rue 1er juin, 5000, Monastir, Tunisia. ouanes.islem@gmail.com.

ABSTRACT

Background: Empiric antibiotic therapy is routinely prescribed in patients with acute COPD exacerbations (AECOPD) requiring ventilatory support on the basis of studies including patients conventionally ventilated. Whether this practice remains valid to current management with first-line non-invasive ventilation (NIV) is unclear.

Methods: In a cohort of ICU patients admitted between 2000 and 2012 for AECOPD, we analyzed the trends in empiric antibiotic therapy and in primary ventilatory support strategy, and their respective impact on patients' outcome.

Results: 440 patients admitted for 552 episodes were included; primary NIV use increased from 29 to 96.7 % (p < 0.001), whereas NIV failure rate decreased significantly (p = 0.004). In parallel, ventilator-associated pneumonia (VAP) rate, VAP density and empiric antibiotic therapy use decreased (p = 0.037, p = 0.002, and p < 0.001, respectively). These figures were associated with a trend toward lower ICU mortality rate (p = 0.058). Logistic regression showed that primary NIV use per se was protective against fatal outcome [odds ratios (OR) = 0.08, 95 %CI 0.03-0.22; p < 0.001], whereas NIV failure, VAP occurrence, and cardiovascular comorbidities were associated with increased ICU mortality [OR = 17.6 (95 %CI 5.29-58.93), 11.5 (95 %CI 5.17-25.45), and 3 (95 %CI 1.37-6.63), respectively]. Empiric antibiotic therapy was associated with decreased VAP rate (log rank; p < 0.001), but had no effect on mortality (log rank; p = 0.793).

Conclusions: The sustained increase in NIV use allowed a decrease in empiric antibiotic prescriptions in AECOPD requiring ventilatory support. Primary NIV use and its success, but not empiric antibiotic therapy, were associated with a favorable impact on patients' outcome.

No MeSH data available.


Related in: MedlinePlus