Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis:: benefits of intensive care?
Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis:: benefits of intensive care?
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DOI：
10.1007/s001340000768
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发表时间：
2001-01-01
影响因子：
38.9
通讯作者：
Installé, EJ
中科院分区：
文献类型：
--
作者：
Bulpa, PA;Dive, AM;Installé, EJ
目的：侵袭性肺曲霉病（IPA）越来越被认为是使用皮质类固醇治疗的慢性阻塞性肺疾病（COPD）患者急性呼吸衰竭的原因。对于这些患者，通常需要入住重症监护室（ICU）进行生命支持和机械通气。这种方法是否能改善预后尚不清楚。设计和设置：回顾性研究，在一所大学医院重症监护室。患者：1993年11月至1997年12月，23例COPD患者在我们的ICU收治，并接受抗真菌药物可能IPA.Interventions：无。测量和结果：的临床特征和结果进行了审查。IPA的诊断被分类为确诊（阳性肺组织活检和/或尸检）或很可能（从气道重复分离曲霉菌，临床和放射学结果一致）。在23例接受曲霉菌治疗的患者中，16例符合IPA的这些标准。研究了除一名患者外，所有患者均在家中使用类固醇，所有患者在住院期间均增加类固醇。12名患者的支气管痉挛加重，引发急性呼吸衰竭。在ICU住院期间，所有患者都需要机械通气治疗急性呼吸衰竭。虽然开始时IPA怀疑（0.5-1.5毫克/公斤，每天），所有患者死于感染性休克（n = 5）或多器官功能衰竭。结论：气管插管COPD患者IPA的预后不良，尽管抗真菌治疗表明，需要进一步的研究，以确定这些患者的ICU管理的限制和适应症。
Objectives: 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.Design and setting: Retrospective study in a university hospital intensive care unit.Patients: Between November 1993 and December 1997, 23 COPD patients were admitted in our ICU and received antifungal agents for possible IPA.Interventions: None.Measurements and 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.