Pneumonia, Ventilator-Associated
Conditions
Keywords
colistin, aerosol, ventilator associated pneumonia, nephrotoxicity, intravenous
Brief summary
the management of Ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) gram-negative bacilli (GNB) represent a real therapeutic dilemma in intensive care unit (ICU). Colistin remains an effective agent against MDR GNB. However, because of its side effects, mainly nephrotoxicity, other modalities than the intra venous (IV) route should be tried. Several recent data emphasize the interest of inhaled route. The investigators purpose was to evaluate the effectiveness and systemic toxicity of aerosolized colistin in ventilator associated pneumonia.
Detailed description
prospective, randomized, single-blind study comparing two groups of patients treated with aerosolised (AS) colistin versus colistin intravenously (IV). Included were patients who have mechanical ventilation over 48 hours and that have developed a VAP. A VAP was defined as a CPIS (Clinical Pulmonary Infection Score) \>6. Exclusion criteria were septic shock and/or bacteraemia. Included patients were divided into two randomized groups. The 1st received colistin in AS as 4 MU by nebulisation 3 times per 24 h. The 2nd received colistin in IV as a loading dose of 9 MU followed by 4.5MU two times per 24 h. Colistin was given for 14 days or until extubation. Patients were followed for 28 days. Therapeutic efficacy was assessed by a primary outcome: the cure of VAP at day 14 of therapy and defined as resolution of clinical and biological signs of infection that means a CPIS\< 6 and bacteriological eradication. Secondary outcomes: duration of mechanical ventilation, ICU stay-length and mortality at day 28. Systemic toxicity was assessed by the occurrence of acute renal failure (ARF) defined as increase of plasma creatinine more than 1.5 times its base value.
Interventions
DRUGAS colistin and imipenem
colimycin (colistin) powder (1 million units (MU) by flakon) by AS route in addition to imipenem
DRUGIV colistin and imipenem .
colimycin (colistin) powder (1 MU by flakon) by intravenous route in addition to imipenem
DRUGAS colimycin (colistin)
nebulisation of colimycin (colistin) for 30 minutes 3 times per day during at least 14 days. Nebulisation was made via an ultrasonic vibrating plates nebulizer (Aeroneb Pro® Aerogen Nektar Corporation, Galway, Ireland).
DRUGIV colimycin (colistin)
intravenous colimycin (colistin) : 9 MU during 60 minutes followed by 4.5 million units 2 times per day
DRUGIV colistin and imipenem
IV imipenem 1 g three times per day
Sponsors
Tunis University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Critically ill patients older than 18 years, with mechanical ventilation during more than 48 hours, and who have presented a Ventilator associated Pneumonia (VAP) defined as a CPIS (Clinical Pulmonary Infection Score) of more than six
Exclusion criteria
* Age \<18 years * Pregnancy * Septic shock
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| cure of VAP | day 14 of therapy | a CPIS (clinical pulmonary infection score) less than 6 and bacterial eradication |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| occurrence of acute renal failure | From date of randomization until the time of the cessation of colistin, assessed up 14 days on average | an acute renal failure was defined as increase of plasma creatinine more than 1.5 times its base value. |
| duration of mechanical ventilation | From date of randomization until the time of weaning from ventilator, an average of 14 days | — |
| length of stay in intensive unit | from randomisation until the time of patient discharge, an average of 28 days | — |
Other
| Measure | Time frame |
|---|---|
| all cause mortality | 28 days |
Countries
Tunisia
Outcome results
None listed