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Clinical Investigations in Critical CarePredictors of Outcome for Patients With COPD Requiring Invasive Mechanical Ventilation
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
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