Acute respiratory failure secondary to chronic obstructive pulmonary disease treated in the intensive care unit: a long term follow up study

D Breen, T Churches, F Hawker, P J Torzillo, D Breen, T Churches, F Hawker, P J Torzillo

Abstract

Background: Traditionally, patients with acute respiratory failure due to chronic obstructive pulmonary disease (COPD) admitted to the intensive care unit (ICU) are believed to have a poor outcome. A study was undertaken to explore both hospital and long term outcome in this group and to identify clinical predictors.

Methods: A retrospective review was carried out of consecutive admissions to a tertiary referral ICU over a 6 year period. This group was then followed prospectively for a minimum of 3 years following ICU admission.

Results: A total of 74 patients were admitted to the ICU with acute respiratory failure due to COPD during the study period. Mean forced expiratory volume in 1 second (FEV1) was 0.74 (0.34) l. Eighty five per cent of the group underwent invasive mechanical ventilation for a median of 2 days (range 1-17). The median duration of stay in the ICU was 3 days (range 2-17). Survival to hospital discharge was 79.7%. Admission arterial carbon dioxide tension (PaCO2) and APACHE II score were independent predictors of hospital mortality on multiple regression analysis. Mortality at 6 months, 1, 2, and 3 years was 40.5%, 48.6%, 58.1%, and 63.5%, respectively. There were no independent predictors of mortality in the long term.

Conclusions: Despite the need for invasive mechanical ventilation in most of the study group, good early survival was observed. Mortality in the long term was significant but acceptable, given the degree of chronic respiratory impairment of the group.

References

    1. N Engl J Med. 1969 Feb 20;280(8):397-404
    1. Am Rev Respir Dis. 1966 Feb;93(2):215-22
    1. Am Rev Respir Dis. 1973 Dec;108(6):1373-83
    1. Arch Intern Med. 1973 Dec;132(6):865-8
    1. Ann Intern Med. 1974 Jan;80(1):54-7
    1. Am Rev Respir Dis. 1975 Jun;111(6):719-24
    1. Am Rev Respir Dis. 1979 Jun;119(6):895-902
    1. Lancet. 1980 Mar 1;1(8166):467-70
    1. Chest. 1982 Sep;82(3):310-4
    1. Crit Care Med. 1985 Oct;13(10):818-29
    1. Am Rev Respir Dis. 1986 Jan;133(1):14-20
    1. Chest. 1987 Apr;91(4):515-21
    1. Chest. 1987 Dec;92(6):971-8
    1. Chest. 1989 Feb;95(2):398-405
    1. Chest. 1993 Sep;104(3):854-60
    1. Chest. 1994 Feb;105(2):469-74
    1. Crit Care Clin. 1994 Jan;10(1):197-215
    1. Am J Med. 1995 Mar;98(3):272-7
    1. Am J Respir Crit Care Med. 1995 Jun;151(6):1799-806
    1. N Engl J Med. 1995 Sep 28;333(13):817-22
    1. JAMA. 1995 Dec 20;274(23):1852-7
    1. Am J Med. 1997 Mar;102(3):239-44
    1. Ann Intern Med. 1998 May 1;128(9):721-8
    1. Respir Med. 1998 Feb;92(2):156-61
    1. Am Rev Respir Dis. 1972 Jun;105(6):932-43

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