The Effect of Use of Anidulafungin on Failure of Weaning Due to Ventilator-associated Pneumonia which Complicates Contused Lungs

Failure of weaning is considered as one of the most difficult challenges for any intensivist, especially in the devitalized lung due to infected lung contusion. Unsatisfactory results with prolonged treatment with the proper broad-spectrum antibiotics raise the point of exclusion of candidemia or suspected pulmonary candidiasis which is considered a major problem not only because of its increasing rate (2-10 per 1000 ICU admission) but also because of its difficult diagnosis. Patients with failure of weaning due to unresolved VAP (Ventilator-associated Pneumonia) after receiving broad-spectrum antibiotics for more than 10 days, especially in preexisting severe lung contusion should be put on empirical systemic antifungal. Echinocandins are a new class of antifungal drugs used as a reliable class for empirical systemic antifungal treatment.

The study aims to evaluate and compare the effect of the use of anidulafungin on weaning from the ventilator due to VAP which complicates traumatized contused lungs after 2 weeks from ventilation.

This was a prospective double-blind study done on 200 patients admitted to King Abdulaziz Specialized Hospital, Taif, KSA between March 2015 and August 2018 in surgical ICU with the failure of weaning due to Ventilator Associated Pneumonia (VAP) which complicated contused lungs. Group (A) 100 patients started on antibiotics regimen according to qualitative culture for 2 weeks, while group (B) 100 patients received anidulafungin with the antibiotics regimen.

In this study, diagnosis of lung contusion was made by Computerized Axial Tomography (CT) chest, while VAP was diagnosed by a modified Clinical Pulmonary Infection Score (CPIS). A score of 6 or more was considered to be VAP.

Comparing the data of the patients in the 3 studied periods (1^st 5 days, 2^nd 5 days and last 4 days) controlled tracheal secretion was recorded in 15, 38 and 46 patients in group A, respectively in the 3 studied periods compared to 28, 75 and 83 in group B. Less parenchymatous lung infiltration in the chest X-ray found was in 12, 40 and 48 patients in group A compared to 24, 88 and 91 patients in group B. Improvement of the hypoxic index in 48, 76 and 85 patients in group A was compared to 66, 90 and 98 patients in group B. Normalization of temperature in 16, 36 and 54 patients in group A, while 40, 76 and 90 patients in B and reduction of total leucocytic count in 18, 35 and 57 patients in group A, while 38, 70 and 87 patients in group B were observed. There were 15 out of 98 patients in Group A who did not weaned, while only 5 out of 100 patients in group B failed to be weaned from mechanical ventilation within the study period (2 weeks).

The use of anidulafungin with proper antibiotics in patients with failure of weaning due to VAP which complicated the contused lung was efficiently treated and reduced the morbidity by accelerating the weaning from the ventilator compared to the use of proper antibiotics alone.