Chest
Clinical InvestigationsSevere COPD and Acute Respiratory Failure: Correlates for Survival at the Time of Tracheal Intubation
Section snippets
Patient Selection
During the period Jan 1, 1987 to Jan 31, 1992, data were recorded prospectively on all Jackson Veterans Affairs Medical Center MICU patients with suspected COPD and ARF requiring MV. Severe COPD was defined as a baseline FEV1 less than 1 L among patients with compatible history and physical findings of COPD. Criteria for inclusion in the study cohorts included prior spirometric confirmation of fixed airways obstruction during a period of clinical stability and the development of ARF requiring
Battent Characteristics
During the study period, 73 episodes of ARF requiring tracheal intubation and MV occurred among patients with suspected COPD. Fifteen (21 percent) of these episodes involved patients who had not been followed in clinics or who lacked prior pulmonary function testing. The 39 episodes of ARF complicating severe COPD, occurring among 33 patients, were studied in detail. Four patients were treated for two episodes of ARF, and one patient was treated for three episodes of ARF. These episodes were
Discussion
The natural history of COPD has been studied extensively over the past 30 years. Several variables have been correlated with survival. These positive correlates include a slow decline of lung function as assessed by forced expiration maneuvers, younger age, higher baseline FEV1 (especially postbronchodilator), active functional status, and the absence of cor pulmonale.11, 16, 17 Less data have accumulated regarding the clinical course of the subset of patients with severe COPD. Long-term
Appendix
The outcome modeling formulas for patients with severe COPD were produced via stepwise logistic regression analysis and incorporate the numeric serum albumin level (g/dl) and the presence (1) or absence (0) of pulmonary infiltrates on chest radiography (CXR). The probability of ARF survival or nonsurvival is as follows:
The outcome
References (28)
- et al.
Temporal trends in chronic obstructive lung disease case fatality in hospitalized US veterans: 1970-1987
Chest
(1991) - et al.
Determinants of weaning and survival among patients with COPD who require mechanical ventilation for acute respiratory failure
Chest
(1989) - et al.
Failure to predict six-month survival of patients with COPD requiring mechanical ventilation by analysis of simple indices
Chest
(1987) - et al.
Determinants of immediate survival among chronic respiratory insufficiency patients admitted to an intensive care unit for acute respiratory failure
Chest
(1992) - et al.
Predictors of survival in subjects with chronic airflow limitation
Am J Med
(1983) - et al.
Controlled oxygen administration in acute respiratory failure in chronic obstructive pulmonary disease
Am J Med
(1978) - et al.
Clinical outcome of respiratory failure in patients requiring prolonged (>24 hours) mechanical ventilation
Chest
(1986) - et al.
The APACHE III prognostic system
Chest
(1991) Physician decisions regarding life support in the intensive care unit
Chest
(1992)- et al.
Medical futility: its meaning and ethical implications
Ann Intern Med
(1990)