Respiratory Failure Required Mechanical Ventilation in Patients with Chronic Obstructive Pulmonary Disease Exacerbations:Impact of ventilator -associated pneumonia to patient outcomes

Background:The impact of VABP to the patient outcomes in intubated COPD patients remains unclear and identification of  predictors may help clinicians to improve poor  outcomes through their modification. Purpose:To determine the impact of VABP on ICU mortality in patients with severe exacerbations of COPD required ICU admission and intubation. Methods:This  study was performed at the department pulmonary and  critical care department of university teaching hospital during a 5-year  period,from December 2017 to January 2022. Results: 109 mechanically ventilated patients were included and 52 of them has been developed microbilogically confirmed VABP.ICU mortality was hgiher in VABP associated COPD patients(43.9% vs 17.3%;p<0.001).Risk factors for VABP  were:older age(p<0.001 ),low BMI(p<0.02),concominant bronchiectasis(p<0.001);overuse of SCs (2.25[0.75-6.44];p<0.003), use of antibiotics in the past 90 days (2.58[0.88-5.76];p=0.002),and  ICSs(p<0.005).MDR pathogens were common was associated with prolonged MV (p<0.001),prolonged ICU stay (p<0.001),higher radiographic(p<0.01) and SOFA score(p<0.001), septic shock required vasopressors and SCs(2.44[0.82-5.78];p<0.002) and an increased mortality(2.11[0.76-4.21];p<0.01).High radiographic score (p<0.01),low pH (p<0.002),high PaCO2 (p=0.003),low P/F ratio (p=0.002) and septic shock at the day of VABP diagnosis(p=0.001) were as independent risk factors for ICU mortality. Conclusion:Evaluation of risk factors predicting ICU mortality in intubated COPD patients and complicated with VABP is crucial for further  their modification and possible reduction of mortality