Abstract
Background: The in-hospital mortality rate of patients with Chronic Obstructive Pulmonary Disease (COPD) submitted to Invasive Mechanical Ventilation (IMV) is recognized as being high.
The authors aim to characterize this population and to identify mortality predictive factors.
Methods: Retrospective study of the clinical records of 67 COPD patients with IMV admitted in the Respiratory Intensive Care Unit (ICU) of Lisbon-North Hospital Centre between January 2005 and August 2009.
Results: The majority were male (91%), with an average of 69±10 yrs and 25% were active smokers. The FEV1 was 40±18%, with 55% being subjected to Long Term Oxygen Therapy and 18% to domiciliary Non Invasive Ventilation (NIV).
The aetiology of exacerbation was mostly infectious (78%). They required 16±24 days of IMV. The ICU mortality rate was 24% and the global hospital mortality rate was 40%.
Two groups were evaluated concerning mortality.
The statistically significant (p<0,05) prognostic factors were: older patients (75 vs. 66 yrs), lower BMI (24 vs. 26 kg/m2), pneumonia (40% vs. 15%), longer in-hospital period before ICU admission (8 vs.3 days), previous acute NIV (67% vs. 33%) and higher severity score at admission (SAPS II 44vs. 35; APACHE II 27vs. 20).
A significant association with mortality, through binary logistic regression, was establish: NIV pre-IMV (OR=4.92; IC95%=1,42-16,98 p<0,012) and the APACHE II severity score (OR=1,13; IC95%=1,03-1,24 p<0,008).
Conclusions: Mortality was associated to a higher severity at admission and extended period under NIV whilst preceding the admission in ICU. The data may be relevant through an early recognition of failure situations in patients with previous NIV.
- © 2011 ERS