Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic pulmonary disease. JAMA 274: 1852-1857

Department of Anesthesiology, George Washington University, Washington, DC, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 01/1996; 274(23):1852-7. DOI: 10.1001/jama.274.23.1852
Source: PubMed

ABSTRACT To describe outcomes and identify variables associated with hospital and 1-year survival for patients admitted to an intensive care unit (ICU) with an acute exacerbation of chronic obstructive pulmonary disease (COPD).
Prospective, multicenter, inception cohort study.
Forty-two ICUs at 40 US hospitals.
A total of 362 admissions for COPD exacerbation selected from the Acute Physiology and Chronic Health Evaluation (APACHE) III database of 17,440 ICU admissions.
Hospital mortality for the 362 admissions was 24%. For the 167 patients aged 65 years or older, mortality was 30% at hospital discharge, 41% at 90 days, 47% at 180 days, and 59% at 1 year. Median survival for all patients was 224 days, and median survival for the patients who died within 1 year was 30.5 days. On multiple regression analysis, variables associated with hospital mortality included age, severity of respiratory and nonrespiratory organ system dysfunction, and hospital length of stay before ICU admission. Development of nonrespiratory organ system dysfunction was the major predictor of hospital mortality (60% of total explanatory power) and 180-day outcomes (54% of explanatory power). Respiratory physiological variables (respiratory rate, serum pH, PaCO2, PaO2, and alveolar-arterial difference in partial pressure of oxygen [PAO2-PaO2]) indicative of advanced dysfunction were more strongly associated with 180-day mortality rates (22% of explanatory power) than hospital death rates (4% of explanatory power). After controlling for severity of illness, mechanical ventilation at ICU admission was not associated with either hospital mortality or subsequent survival.
Patients with COPD admitted to an ICU for an acute exacerbation have a substantial hospital mortality (24%). For patients aged 65 years or older, mortality doubles in 1 year from 30% to 59%. Hospital and longer-term mortality is closely associated with development of nonrespiratory organ system dysfunction; severity of the underlying respiratory function substantially influences mortality following hospital discharge. The need for mechanical ventilation at ICU admission did not influence either short- or long-term outcomes. Physicians should be aware of these relationships when making treatment decisions or evaluating new therapies.

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    • "All the cases that showed failure with NIPPV had comorbidities as diabetes, hypertension, pneumonia and congestive heart failure. This was in agreement with many studies, which stated that NIPPV failure was greater in patients with medical comorbidities either acute or chronic [16] [17] [18], especially cardiovascular diseases [19] and pneumonia [17]. This may be due to the associated refractory hypoxemia and hypoxemic respiratory failure [20]. "
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    ABSTRACT: 27 patients diagnosed as chronic obstructive pulmonary disease (COPD) came with acute hypercapnic respiratory failure due to COPD and met the inclusion and exclusion criteria. They were managed by non invasive positive pressure ventilation (NIPPV). 21 cases showed success and 6 cases showed failure and were put on invasive mechanical ventilation within the first 24 h. It was shown that before initiation of NIPPV, the failed cases had significantly higher Body Mass Index (BMI) 34.7 compared to 28.1 in successful cases and significantly lower pH 7.20 ± 0.05 compared with 7.27 ± 0.04. After 1 h of initiation of NIPPV, the successful group showed improvement regarding pH and PaCO2, while the failed group showed worsening of the same parameters, with a significant difference (p value <0.001, 0.005), respectively. After 4 h, there was improvement in both groups regarding pH which reached normalization in the successful group, PaCO2, and PO2, with no statistical significant difference. There were significant differences in the respiratory rate (p value < 0.001), and the expiratory positive airway pressure (EPAP) (p value 0.024) between the two groups. Thus we can conclude that the use of NIPPV in such patients can be successful in around 78% of cases, however failure can be predicted by high BMI, initial lower pH and higher PaCO2, insignificant response to NIPPV after 1 h. They also show increased respiratory rate and need for higher expiratory positive airway pressure.
    04/2014; 63(2). DOI:10.1016/j.ejcdt.2013.12.018
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    • "These results also explain that why many of the preventive strategies such as use of topical antibiotics/antiseptics, subglottic secretion drainage, chest physiotherapy, and so on successfully reduce the incidence of VAP but not the mortality caused by this.[262728] Our study showed higher mortality rate (51%) than reported in the literature (2.5-30%).[29303132] There are various factors such as severity of the disease, presence of type-2 respiratory failure, high acute physiology and chronic health evaluation (APACHE) score, presence of hypoxemia or cor pulmonale, and so on which may affect the mortality among these patients.[33] "
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    Lung India 03/2014; 31(1):4-8. DOI:10.4103/0970-2113.125886
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    • "Although IMV is associated with higher mortality rates, it was not a predictor of in-hospital mortality in the current study. This is also similar to the findings by Seneff et al.[51] and Afessa et al. [12]. The current study identified several predictors of IMV (Table 3). "
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    ABSTRACT: Predictors of in-hospital mortality and need for invasive mechanical ventilation (IMV) in chronic obstructive pulmonary disease (COPD) patients presenting with acute hypercapnic respiratory failure (AHRF) are yet lacking, but warranted in elderly population. Formulating a scoring system may aid prognostication.
    07/2013; 62(3):393-400. DOI:10.1016/j.ejcdt.2013.07.003
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