Chronic obstructive pulmonary disease: hospital and intensive care unit outcomes in the Kingdom of Saudi Arabia

Abstract

BackgroundThere is little data surrounding the survival of patients with chronic obstructive pulmonary disease (COPD) who are admitted to the critical care unit with exacerbation of symptoms. We conducted a study to measure the in-hospital and intensive care unit (ICU) outcomes of patients admitted with COPD exacerbation, and identified the related prognostic factors.MethodWe performed a retrospective cohort study of patients who were admitted to the adult ICU between January 2006 and July 2011 for COPD exacerbation in King Abdulaziz National Guard Hospital, Al-Hasa, Saudi Arabia.ResultsDuring the study period, a total of 119 patients were admitted to the ICU with acute respiratory failure attributed to COPD exacerbation. The mean age was 72 ± 13 years, and 44 (37%) were females. The main cause of respiratory failure was infection, which occurred in 102 (86%) patients. Thirty-nine (33%) of the admitted patients were mechanically ventilated, and the median duration was 2.6 (1–42) days. The median lengths of the ICU and hospital stays were 3 (1–40) and 9 (2–43) days, respectively. The ICU mortality was 6%, and hospital mortality was 11%. Low Glasgow Coma Scale on admission, intubation, duration of mechanical ventilation, current smoking, tracheostomy, cardiopulmonary arrest, and the development of acute renal failure were associated with higher hospital mortality.ConclusionEarly ICU and hospital mortality is low for COPD patients who have been admitted to the ICU with exacerbation. Low Glasgow Coma Scale scores on admission, intubation, prolonged use of mechanical ventilation, and the development of acute renal failure were identified as risk factors associated with increased hospital mortality.

Reasons for ICU Demand and Long-term Follow-up of a Chronic Obstructive Pulmonary Disease Cohort

“…Th e success rate of NIV in this group is between 54% and 85% (7,26,27). Confalonieri and colleagues generated a prediction chart that estimates a 70% NIV failure rate if: the pH on admission to ICU is < 7.25, a Glasgow Coma Scale <11, and an APACHE II score >29 (28).…”

“…Studies researching COPD patient outcome following ICU admission and a long-term ICU stay have largely excluded any other primary reasons, other than acute exacerbation of COPD (6,7,8). Th ere are reports on ICU outcomes of COPD patients with pneumonia (9,10); however, there is limited data on these COPD patients regarding all causes for ICU demand and long-term stay, and mortality after ICU discharge.…”

COPD exacerbations admitted to intensive care unit. Organization, mortality, and noninvasive or invasive mechanical ventilation strategies: are they sufficiently well known?

“…We read with interest the survival analysis of chronic obstructive pulmonary disease (COPD) patients who are admitted to critical care units with exacerbation, conducted in Saudi Arabia by Alaithan et al1 This study makes an important contribution on the real practice of intensive care units (ICUs). The authors, in the overall results, provided some great information similar in some aspects to previous epidemiologic surveys where a low level of consciousness on admission, need for endotracheal intubation (ETI), being a current smoker, cardiopulmonary arrest, tracheostomy, and development of acute renal failure are associated with higher ICU and hospital mortality.…”

“…Second, a relevant aspect that could influence hospital practices and COPD outcomes in this study1 was that only 55% of COPD exacerbations received NIV as initial first line treatment and assumed that the remaining patients received oxygen therapy alone. These data may have health care implications for ICUs, because it could be refecting three potential scenarios: (1) delayed NIV applications, (2) staff training and skills, or (3) limited access to the NIV therapy (the availability of beds in ICU ward).…”

“…However, there are other factors with recognized influence that were not analyzed, such as body mass index (BMI),7 lower health status, nutritional status, or nonrespiratory organ system dys-function 2,3,8. Alaithan et al1 considered that ICU mortality was associated with a longer duration of mechanical ventilation and lower Acute Physiology and Chronic Health Evaluation II (APACHE II)2,3 score, but this is a controversial aspect by other epidemiological published studies 2,3. Additionally, COPD readmissions,7,8 existence of do not-ETI orders, and NIV palliative in severe exacerbation of COPD, were not taken into account 9…”