In-Hospital and 5-Year Mortality of Patients Treated in the ICU for Acute Exacerbation of COPD

Ai-Ping, C.; Lee, Kang Hoe; Lim, Tow Keang

doi:10.1378/chest.128.2.518

Cited by 178 publications

(89 citation statements)

References 34 publications

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“…Recurrent episodes of acute respiratory failure often complicate their clinical course [3, 4], being associated with frequent hospital and intensive care unit (ICU) admissions [5]. …”

Section: Introductionmentioning

confidence: 99%

Home Non-Invasive Mechanical Ventilation and Long-Term Oxygen Therapy in Stable Hypercapnic Chronic Obstructive Pulmonary Disease Patients: Comparison of Costs

Clini

Magni²,

Crisafulli³

et al. 2008

Respiration

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Background: A cost analysis of nocturnal non-invasive ventilation (NNV) in stable chronic obstructive pulmonary disease (COPD) patients would be helpful in decision making, when the balance between the increased demand and the availability of resources should be checked. Objectives: Based on data from the Italian trial in stable hypercapnic COPD patients, this study compares the cost of care associated with the use of NNV when added to the usual long-term oxygen therapy (LTOT) with the cost of care of LTOT regimen alone. Methods: Cost was calculated in 77 of 90 patients included into that trial. Analysis included drug therapy, hospitalisations due to acute exacerbation, oxygen and ventilator equipments. An estimation of charges was made according to the national sources of cost for drugs and hospital admissions and the actualised reimbursement for the home care provided to both oxygen and ventilator users. The cost/day comparison was made between the individual patients in the 2 groups (NNV + LTOT, n = 35; LTOT, n = 42). Results: The mean cost of drugs and oxygen was similar in both groups, whereas the cost of hospitalisation tended to be lower in NNV + LTOT compared to LTOT alone (8.25 ±10.29 vs. 12.50 ± 20.28 EUR/patient/day, p < 0.05). Inclusion of the ventilator equipment increased the total cost to 23.73 EUR/day in the NNV + LTOT compared to 21.42 EUR/day in the LTOT group (not significant). Conclusions: The present report suggests that long-term management with addition of non-invasive ventilation does not increase costs compared with the usual LTOT regimen: the hospital-related costs were reduced when using the ventilator in these hypercapnic COPD patients.

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“…Recurrent episodes of acute respiratory failure often complicate their clinical course [3, 4], being associated with frequent hospital and intensive care unit (ICU) admissions [5]. …”

Section: Introductionmentioning

confidence: 99%

Home Non-Invasive Mechanical Ventilation and Long-Term Oxygen Therapy in Stable Hypercapnic Chronic Obstructive Pulmonary Disease Patients: Comparison of Costs

Clini

Magni²,

Crisafulli³

et al. 2008

Respiration

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“…The prediction of mortality in COPD patients receiving mechanical ventilation in the ICU for ARF is not clear [19]. It is not clear that the prediction of in-hospital mortality can be done from covariates recorded at the time of intubation, including physiologic variables [20]. However, in the present study, the increase in the burden of morbidity was significantly associated with the angle (table 3).…”

Section: Discussionmentioning

confidence: 61%

Expiratory Flow-Volume Loop Profile and Patient Outcome in Chronic Obstructive Pulmonary Disease in Acute Respiratory Failure: A Prospective Observational Study in a Single Intensive Care Unit

Porot

Ernesto²,

Leray³

et al. 2011

Respiration

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Background: Expiratory flow-volume (EFV) loops are continuously displayed on the screen of intensive care unit (ICU) ventilators. Objectives: It was the aim of this study to investigate the relationships of EFV to chronic obstructive pulmonary disease (COPD) patient outcome. Methods: This is a prospective study on COPD patients who received invasive mechanical ventilation for acute respiratory failure in the ICU. Within the 24-hour post-intubation period, the angle of the EFV slope during the last 50% of expiration was computed and patients were stratified into 4 quartiles. Resistance, compliance of the respiratory system and change in end-expiratory lung volume above relaxation volume were assessed. Patients were followed up to hospital discharge. The main outcome was hospital mortality. Secondary outcomes were ICU mortality, length of ICU stay, duration of invasive ventilation, number of intubations, oxygen and non-invasive ventilation. Results: Thirty-eight patients were analysed. The first quartile comprised 9 patients (median angle 11°, interquartile range 8–12), the second 10 patients (median angle 26°, range 19–30), the third 10 patients (median angle 42°, range 39–46), and the fourth 9 patients (median angle 53°, range 49–64). Hospital and ICU mortality were not different between groups. Lengths of ICU and hospital stay and length of invasive ventilation were significantly different between groups, with the highest values observed in the first quartile. The rate of oxygen use and non-invasive ventilation in the ICU and at hospital discharge was significantly different between groups, with the highest rate observed in the first quartile. There was a significant negative correlation between angle and resistance, compliance of the respiratory system and change in end-expiratory lung volume above the relaxation volume. Conclusion: The slope of the angle during the last 50% of expired volume in the COPD patients was associated with worsened respiratory mechanics and higher morbidity.

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“…Under these circumstances, 10% of the patients will die in hospital [1,2] and the 1-year mortality rate can be as high as 20–40% [1,2]. The situation is even worse when exacerbation leads to mechanical ventilation in the intensive care unit (ICU), where the in-hospital and 1-year mortality is striking, approximating 25 [3,4,5,6] and 40–60% [3,4,7], respectively. Although the use of non-invasive ventilation has considerably reduced the requirement for invasive mechanical ventilation [8], this life support measure is still required in a significant portion of COPD patients [9].…”

mentioning

confidence: 99%

“…The fact that most patients can eventually be weaned from the ventilator [5,13] has to be balanced with the knowledge that moderate-term survival rate is poor [3,4,6,7], and, most importantly, that quality of life is often unsatisfactory in the majority of survivors [14]. The decision to pursue ventilation in this context is difficult and should be made based on the severity and the irreversibility of the underlying lung disease, the age of the patient, the baseline health status and, most of all, personal choices (patient and family).…”

mentioning

confidence: 99%

“…Low body weight, poor functional status, advanced age, low albumin levels, very severe airflow obstruction, chronic hypercapnia, systemic corticosteroid treatment, comorbidities and oxygen dependence have all been associated with poor survival [2,6,7,15,16]. However, given the huge heterogeneity in the predictors of survival across studies, these clinical parameters cannot be used to precisely estimate survival and the outcome of mechanical ventilation in a given patient.…”

mentioning

confidence: 99%

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Physiology to Assist Bedside Prognostication in Mechanically Ventilated Patients with Chronic Obstructive Pulmonary Disease

Maltais¹

2012

Respiration

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In-Hospital and 5-Year Mortality of Patients Treated in the ICU for Acute Exacerbation of COPD

Cited by 178 publications

References 34 publications

Home Non-Invasive Mechanical Ventilation and Long-Term Oxygen Therapy in Stable Hypercapnic Chronic Obstructive Pulmonary Disease Patients: Comparison of Costs

Home Non-Invasive Mechanical Ventilation and Long-Term Oxygen Therapy in Stable Hypercapnic Chronic Obstructive Pulmonary Disease Patients: Comparison of Costs

Expiratory Flow-Volume Loop Profile and Patient Outcome in Chronic Obstructive Pulmonary Disease in Acute Respiratory Failure: A Prospective Observational Study in a Single Intensive Care Unit

Physiology to Assist Bedside Prognostication in Mechanically Ventilated Patients with Chronic Obstructive Pulmonary Disease

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