慢性阻塞性肺疾病（COPD）与插管重症患者微误吸风险增加有关吗？

Is COPD associated with increased risk for microaspiration in intubated critically ill patients?

作者信息

Degroote Thècle, Jaillette Emmanuelle, Reignier Jean, Zerimech Farid, Girault Christophe, Brunin Guillaume, Chiche Arnaud, Lacherade Jean-Claude, Mira Jean-Paul, Maboudou Patrice, Balduyck Malika, Nseir Saad

机构信息

Service de Médecine Intensive et Réanimation, Groupe Hospitalier Paris Saint-Joseph, Paris, France.

Critical Care Center, CHU Lille, 59000, Lille, France.

出版信息

Ann Intensive Care. 2021 Jan 11;11(1):7. doi: 10.1186/s13613-020-00794-1.

DOI:10.1186/s13613-020-00794-1

PMID:33428002

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7798009/

Abstract

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.

摘要

背景

尽管慢性阻塞性肺疾病（COPD）患者自主呼吸时误吸风险较高，但关于有创通气的COPD患者发生微量误吸的风险尚无相关信息。我们研究的目的是确定COPD与插管重症患者大量微量误吸之间的关系。

方法

这是一项对前瞻性收集数据的回顾性分析，数据来自3项关于接受有创机械通气超过48小时的重症患者微量误吸的随机对照试验。大量微量误吸定义为气管吸出物中胃蛋白酶和/或α-淀粉酶水平显著升高。在所有研究患者中，对48小时内收集的所有气管吸出物进行胃蛋白酶和α-淀粉酶的定量检测。COPD根据肺功能测定标准进行定义。

结果

在纳入的515例患者中，70例（14%）确诊为COPD。分别对3873份和3764份气管吸出物进行了胃蛋白酶和α-淀粉酶的定量检测。COPD患者和非COPD患者的大量微量误吸率无显著差异（70例患者中的62例（89%）对445例患者中的366例（82%），p = 0.25）。同样，两组之间胃内容物大量微量误吸率（53%对45%，p = 0.28）、口咽分泌物大量微量误吸率（71%对71%，p = 0.99）或呼吸机相关性肺炎（VAP）发生率（19%对22%，p = 0.65）均无显著差异。COPD患者和非COPD患者在机械通气时间、ICU住院时间或ICU死亡率方面也无显著差异。