Chest
Volume 119, Issue 6, June 2001, Pages 1840-1849
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Clinical Investigations in Critical Care
Predictors of Outcome for Patients With COPD Requiring Invasive Mechanical Ventilation

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Introduction

Accurate outcomes data and predictors of outcomes are fundamental to the effective care of patients with COPD and in guiding them and their families through end-of-life decisions.

Design

We conducted a retrospective cohort study of 166 patients using prospectively gathered data in patients with COPD who required mechanical ventilation for acute respiratory failure of diverse etiologies.

Results

The in-hospital mortality rate for the entire cohort was 28% but fell to 12% for patients with a COPD exacerbation and without a comorbid illness. Univariate analysis showed a higher mortality rate among those patients who required > 72 h of mechanical ventilation (37% vs 16%; p < 0.01), those without previous episodes of mechanical ventilation (33% vs 11%; p < 0.01), and those with a failed extubation attempt (36% vs 7%; p = 0.0001). With multiple logistical regression, higher acute physiology score measured 6 h after the onset of mechanical ventilation, presence of malignancy, presence of APACHE (acute physiology and chronic health evaluation) II-associated comorbidity, and the need for mechanical ventilation ≥ 72 h were independent predictors of poor outcome.

Conclusions

We conclude that among variables available within the first 6 h of mechanical ventilation, the presence of comorbidity and a measure of the severity of the acute illness are predictors of in-hospital mortality among patients with COPD and acute respiratory failure. The occurrence of extubation failure or the need for mechanical ventilationbeyond 72 h also portends a worse prognosis.

Section snippets

Study Population

Patients with a history of COPD requiring MV who were admitted to the medical ICU service at New England Medical Center during a 4-year period were eligible for participation in this study. The diagnosis of COPD was determined by premorbid pulmonary function testing when available (76 of 166 patients; 56 of 166 patients within 2 years of hospital admission). In the absence of documented airflow obstruction, we used clinical criteria, clinical history with compatible physical findings, and/or

Analysis of the Entire Cohort

One hundred sixty-six patients with COPD requiring MV were admitted to the medical ICU. Eighty-one percent of the patients were admitted from home, 13% were transferred from a CCF, and 1% were transferred from an acute-care hospital. The majority of the population was male, and more than one half had either an APACHE II-defined comorbidity or active malignancy. One third of patients were actively smoking, and one fourth had previously required MV not related to surgery. Seventeen percent of

Discussion

This study represents one of the largest published cohorts of patients with COPD requiring invasive MV for acute respiratory failure and highlights several important points regarding this population. The in-hospital mortality rate of 28% (15% with COPD exacerbation) was lower than that found by most previous authors (Table 4) . Among patients admitted with an exacerbation of COPD and without an APACHE II-defined comorbid illness or malignancy, the mortality rate was only 12%. Although many of

References (48)

  • MA Papadakis et al.

    Prognosis of noncardiac medical patients receiving mechanical ventilation in a veterans hospital

    Am J Med

    (1987)
  • RA Pearlman

    Variability in physician estimates of survival for acute respiratory failure in chronic obstructive pulmonary disease

    Chest

    (1987)
  • SK Epstein et al.

    Effect of failed extubation on the outcome of mechanical ventilation

    Chest

    (1997)
  • F Portier et al.

    Determinants of immediate survival among chronic respiratory insufficiency patients admitted to an ICUs for acute respiratory failure: a prospective multicenter study; the French Task Group for Acute Respiratory Failure in Chronic Respiratory insufficiency

    Chest

    (1992)
  • AA Jeffrey et al.

    Acute hypercapnic respiratory failure in patients with chronic obstructive lung disease: risk factors and use of guidelines for man agement

    Thorax

    (1992)
  • JL Moran et al.

    Acute exacerbations of chronic obstructive pulmonary disease and mechanical ventilation: a reevaluation

    Crit Care Med

    (1998)
  • HJ Sluiter et al.

    Conservative and respirator treatment of acute respiratory insufficiency in patients with chronic obstructive lung disease: a reappraisal

    Am Rev Respir Dis

    (1972)
  • RH Burk et al.

    Acute respiratory failure in chronic obstructive pulmonary disease: immediate and long-term prognosis

    Arch Intern Med

    (1973)
  • PM Warren et al.

    Respiratory failure revisited: acute exacerbations of chronic bronchitis between 1961–68 and 1970–76

    Lancet

    (1980)
  • AF Connors et al.

    Outcomes after acute exacerbation of severe chronic obstructive lung disease: the SUPPORT investigators

    Am J Respir Crit Care Med

    (1996)
  • LJ Kettel et al.

    Treatment of acute respiratory acidosis in chronic obstructive lung disease

    JAMA

    (1971)
  • JM Anon et al.

    Mechanical ventilation of patients on long-term oxygen therapy with acute exacerbations of chronic obstructive pulmonary disease: prognosis and cost-utility analysis

    Intensive Care Med

    (1999)
  • MG Seneff et al.

    Hospital and 1-year survival of patients admitted to ICUs with acute exacerbation of chronic obstructive pulmonary disease

    JAMA

    (1995)
  • JE Spicher et al.

    Outcome and function after prolonged mechanical ventilation

    Arch Intern Med

    (1987)
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