title: Chronic obstructive pulmonary disease and the risk for ventilator-associated pneumonia.
abstract: OBJECTIVE
  To discuss recent data on the relationship between chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP).
  
  
  RESULTS
  Despite increased use of noninvasive ventilation, a large proportion of COPD patients still require invasive mechanical ventilation. Intubated COPD patients are at increased risk for VAP compared with patients without COPD. VAP is associated with increased mortality and duration of mechanical ventilation in these patients. Specific risk factors for VAP in this population include prolonged duration of invasive mechanical ventilation, high incidence of microaspiration and bacterial colonization, and altered local and general host defense mechanisms. Skeletal and diaphragmatic muscle weakness resulting from malnutrition, inflammation, and systemic corticosteroids is the main cause for prolonged mechanical ventilation. Increased risk for microaspiration of contaminated secretions is related to gastro-esophageal reflux, and altered interaction between breathing and deglutition. Defective mucociliary clearance contributes to a high incidence of respiratory tract colonization in these patients. Further, increasing evidence suggests that COPD is associated with immunosuppression promoting pulmonary infection.
  
  
  CONCLUSIONS
  COPD is a risk factor for VAP. Future studies should focus on specific preventive measures in this population.
authors.affiliation: aCritical Care Department, R. Salengro Hospital, CHRU, Lille bEA 2694, Université Nord de France, Lille, France.
authors.forename: Anahita
authors.initials: A
authors.lastname: Rouzé
authors.forename: Aurélie
authors.initials: A
authors.lastname: Cottereau
authors.forename: Saad
authors.initials: S
authors.lastname: Nseir
mesh_terms: D005764:Gastroesophageal Reflux / Q000150:complications / Q000276:immunology / Q000503:physiopathology*; D006801:Humans; D007165:Immunosuppression Therapy; D008168:Lung / Q000382:microbiology* / Q000503:physiopathology; D053717:Pneumonia, Ventilator-Associated / Q000276:immunology / Q000517:prevention & control*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000276:immunology / Q000503:physiopathology*; D012121:Respiration, Artificial / Q000009:adverse effects*; D012137:Respiratory System / Q000382:microbiology* / Q000503:physiopathology; D012307:Risk Factors