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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

Impact of ventilation method at ICU admission and that of NIV failure on VAP rate and ICU mortality: analysis with Kaplan–Meier method shows that NIV was significantly associated with a decrease in VAP (b) and ICU mortality rates (a), (log rank test, p < 0.001). Conversely, NIV failure was associated with higher rates of VAP and death in the ICU compared with patients ventilated with NIV only (log rank test, p < 0.001) and similarly to primary invasive mechanical ventilation
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Fig4: Impact of ventilation method at ICU admission and that of NIV failure on VAP rate and ICU mortality: analysis with Kaplan–Meier method shows that NIV was significantly associated with a decrease in VAP (b) and ICU mortality rates (a), (log rank test, p < 0.001). Conversely, NIV failure was associated with higher rates of VAP and death in the ICU compared with patients ventilated with NIV only (log rank test, p < 0.001) and similarly to primary invasive mechanical ventilation

Mentions: At ICU admission, 374 patients (67.8 %) were started with NIV as the primary ventilation method, and 178 (32.2 %) were invasively ventilated. Both VAP and ICU mortality rates were significantly higher in patients who received invasive ventilation compared to those who were initially non-invasively ventilated with, respectively, 23.6 versus 5.6 % for VAP rate (Chi square p < 0.001; log rank test, p < 0.001) and 31.8 versus 7 % for ICU mortality (Chi square p < 0.001; log rank test, p < 0.001) (Fig. 4).Fig. 4


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)

Impact of ventilation method at ICU admission and that of NIV failure on VAP rate and ICU mortality: analysis with Kaplan–Meier method shows that NIV was significantly associated with a decrease in VAP (b) and ICU mortality rates (a), (log rank test, p < 0.001). Conversely, NIV failure was associated with higher rates of VAP and death in the ICU compared with patients ventilated with NIV only (log rank test, p < 0.001) and similarly to primary invasive mechanical ventilation
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Impact of ventilation method at ICU admission and that of NIV failure on VAP rate and ICU mortality: analysis with Kaplan–Meier method shows that NIV was significantly associated with a decrease in VAP (b) and ICU mortality rates (a), (log rank test, p < 0.001). Conversely, NIV failure was associated with higher rates of VAP and death in the ICU compared with patients ventilated with NIV only (log rank test, p < 0.001) and similarly to primary invasive mechanical ventilation
Mentions: At ICU admission, 374 patients (67.8 %) were started with NIV as the primary ventilation method, and 178 (32.2 %) were invasively ventilated. Both VAP and ICU mortality rates were significantly higher in patients who received invasive ventilation compared to those who were initially non-invasively ventilated with, respectively, 23.6 versus 5.6 % for VAP rate (Chi square p < 0.001; log rank test, p < 0.001) and 31.8 versus 7 % for ICU mortality (Chi square p < 0.001; log rank test, p < 0.001) (Fig. 4).Fig. 4

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