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. 2023 Sep 19;27(1):359.
doi: 10.1186/s13054-023-04631-2.

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

Louis-Marie Galerneau  1   2 , Sébastien Bailly  3 , Nicolas Terzi  4   3 , Stéphane Ruckly  5 , Maité Garrouste-Orgeas  6 , Johanna Oziel  7 , Vivien Hong Tuan Ha  8 , Marc Gainnier  9 , Shidasp Siami  10 , Claire Dupuis  11 , Jean-Marie Forel  12 , Anaïs Dartevel  4 , Julien Dessajan  13 , Christophe Adrie  14 , Dany Goldgran-Toledano  15 , Virginie Laurent  16 , Laurent Argaud  17 , Jean Reignier  18 , Jean-Louis Pepin  3 , Michael Darmon  19 , Jean-François Timsit  13 ; OUTCOME R. E. A. network
Collaborators, Affiliations

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

Louis-Marie Galerneau et al. Crit Care. .

Erratum in

Abstract

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.

Keywords: Acute exacerbation of chronic obstructive pulmonary disease; Intensive care medicine; Non-ventilator-associated ICU-acquired pneumonia; Prevalence; Prognosis.

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Conflict of interest statement

LMG is supported by Pfizer for attending meetings and/or travel. NT is supported by Pfizer for attending meetings and/or travel and non-financial supports from Gilead outside this work. The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Population Flowchart. AECOPD Acute exacerbation of chronic obstructive pulmonary decease; COPD chronic obstructive pulmonary disease, OUTCOMEREA database multicenter longitudinal database fuelled by ICUs contributing to the OUTCOMEREA Network, ICU intensive care unit, NV-Hospital-AP non-ventilator hospital-acquired pneumonia, NV-ICU-AP non-ventilator-associated intensive care unit acquired pneumonia
Fig. 2
Fig. 2
Cumulative incidences of non-ventilator-associated ICU-acquired pneumonia and ventilator-associated pneumonia in patients admitted in ICU for a severe acute exacerbation of COPD. A Cumulative incidence of non-ventilator-associated ICU-acquired pneumonia from ICU admission in patients admitted to an ICU for a severe acute exacerbation of COPD. B Cumulative incidence of ventilator-associated pneumonia from intubation in ICU for a severe acute exacerbation of COPD (n = 219). ICU intensive care unit, NV-ICU-AP non-ventilator-associated intensive care unit acquired pneumonia, VAP ventilator-associated pneumonia
See this image and copyright information in PMC

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