Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis: benefits of intensive care?
OBJECTIVE
Invasive pulmonary aspergillosis (IPA) is increasingly recognized as a cause of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD) treated with corticosteroids. For these patients admission in intensive care unit (ICU) is often required for life-support and mechanical ventilation. Whether this approach improves outcome is unknown.


METHODS
Retrospective study in a university hospital intensive care unit.


METHODS
Between November 1993 and December 1997, 23 COPD patients were admitted in our ICU and received antifungal agents for possible IPA.


METHODS
None.


RESULTS
The clinical features and the outcome were reviewed. Diagnosis of IPA was classified as confirmed (positive lung tissue biopsy and/or autopsy) or probable (repeated isolation of Aspergillus from the airways with consistent clinical and radiological findings). Among the 23 patients treated for Aspergillus, 16 fulfilling these criteria for IPA were studied. Steroids had been administered at home to all patients but one and were increased during hospitalization in all. Twelve patients suffered a worsening of their bronchospasm precipitating acute respiratory failure. During ICU stay all patients required mechanical ventilation for acute respiratory failure. Although amphotericin B deoxycholate was started when IPA was suspected (0.5-1.5 mg/kg per day), all patients died in septic shock (n = 5) or in multiple-organ failure.


CONCLUSIONS
The poor prognosis of intubated COPD patients with IPA, in spite of antifungal treatment suggests that further studies are required to define the limits and indications for ICU management of these patients.
Department of Intensive Care, Mont-Godinne University Hospital, Université Catholique de Louvain, Yvoir, Belgium. pierre.bulpa@rean.ucl.ac.be
P A
PA
Bulpa
A M
AM
Dive
M G
MG
Garrino
M A
MA
Delos
M R
MR
Gonzalez
P A
PA
Evrard
Y
Y
Glupczynski
E J
EJ
Installé
D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000139:chemically induced / Q000150:complications / Q000401:mortality / Q000628:therapy*; D001530:Belgium / Q000453:epidemiology; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008172:Lung Diseases, Fungal / Q000139:chemically induced / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008173:Lung Diseases, Obstructive / Q000382:microbiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000382:microbiology / Q000628:therapy; D012189:Retrospective Studies
D000935:Antifungal Agents; D005938:Glucocorticoids