Source: Annual Congress 2002 - Clinical aspects of antibiotic and nonantibiotic therapy of pneumonia in the ICU
Disease area: Respiratory critical care, Respiratory infections

Abstract

Insulin resistance and hyperglycemia are common in critically ill patients, even if they have not previously had diabetes. We investigated the incidence and outcome of ventilator-associated pneumonia (VAP) in patients with acute respiratory failure dependently on the need of intravenous admistered insulin therapy (IT) to maintain blood glucose below 180 mg/dl.
From July 1998 to December 2001 we identified 100 patients on mechanical ventilation (MV) initially due to reasons other than pneumonia. The incidence of VAP was 30/100 patients on MV. Fiberoptic bronchoscopic examination and quantitative bacterial cultures (protected brush [threshold: 103 cfu/ml], bronchoalveolar lavage [threshold:104 cfu/ml] or endotracheal aspiration [threshold:104 cfu/ml]) were used to diagnose VAP. Pathogens were isolated in 26/30 patients, in 16 patients resistant gram-negative rods. The need of IT (32 of 100 patients on MV) resulted in a significant increase of VAP incidence during MV (14 of 30 pts. with VAP versus 18 of 70 pts. without VAP, p<0.05). Mortality rates of all patients on MV were not different in patients with (11 of 32 patients, 34%) and without (16 of 68 patients, 24%) IT (p=0.2) and were not different in patients with VAP (5 of 14 with IT, 35% versus 4 of 16 without IT, 25%, p=0.5). The need for IT resulted in a considerable increase of both, in duration of MV (days, median 28 [range 1-258] with IT versus 7.5 [1-178] without IT, p<0.001) and of ICU stay (days, median 34 [range 4-236] with IT versus 9 [1-168]without IT, p<0.001).
The need of IT in patients with acute respiratory failure significantly increases the risk of VAP in mechanically ventilated patients and prolongs the duration of ICU-care and on MV without affecting survival.

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Citations should be made in the following way:
R. Erbes, M. Raffenberg, H. Mauch, H. Lode (Berlin, Germany). Insulin therapy in patients with mechanical ventilation increases the risk for ventilator-associated pneumonia. Eur Respir J 2002; 20: Suppl. 38, 229

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