INTRODUCTION: Invasive pulmonary aspergillosis (IPA) is increasingly recognized as a cause of acute respiratory failure (ARF) in severely COPD patients (pts) treated with corticosteroids. For these pts admission in ICU is often required for life-support and mechanical ventilation (MV). We retrospectively analyzed the outcome of these pts. MATERIAL AND METHODS: Since November 1993, 16 COPD pts (13 males; mean age : 68) were intubated in our ICU for ARF. Diagnosis (dg) of IPA was classified as proved (positive lung tissue biopsy and/or autopsy) (n=6) or as highly probable (repeated isolation of Aspergillus Fumigatus from the sputum with consistent clinical and radiological findings). We reviewed the SAPS II score on admission, the clinical features and the outcome. RESULTS: All pts suffered from a worsening of their bronchospasm precipitating their ARF justifying MV. Their mean FEV1 was 940ml/s (range : 550-1100), SAPS II score : 51 (22-74), mean stay in ICU before intubation :1.8 days(d) (0-12), average duration :1. between admission in ICU and dg: 1.9 d [(-27)-24], 2. between dg and death :11.7d (2-50). Amphotericin B was started immediately after the dg of IPA was suspected (daily dose : 1 - 1.5 mg/kg/d). All pts died in septic shock (n=4) or in MOF. CONCLUSION: In our experience, all severe COPD pts suffering from an ARF requiring admission in ICU for MV in whom IPA was discovered died. Therefore, with our present knowledge and therapeutics, aggressive life-support for these pts should not be recommended.
Full conference title:
The American Lung Association - American Thoracic Association Conference,1998