Determinants of the Length of Mechanical Ventilation in Patients with COPD in the Intensive Care Unit

Background: Exacerbation of chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality, but the effect of metabolic compensation of respiratory acidosis (RA) on mortality is not fully understood. Objective: To investigate the relationship between metabolic compensation and mortality in COPD patients with RA. Methods: We prospectively investigated all COPD patients with RA admitted to the respiratory intensive care unit between February 2001 and March 2007. Two hundred and thirteen patients (159 male, 54 female; mean age 65 ± 10.8 years) were divided into three groups (71 patients each) according to base excess (BE) levels: (1) low BE, (2) medium BE, and (3) high BE. H⁺ concentration was calculated according to their standard formula and BE was calculated according to the Van Slyke equation. Results: The overall mortality rate was 24.9%. The group mortality rates were 32, 17 and 25% in the low, medium and high BE groups, respectively (p = 0.001). When patients were divided into three groups according to the HCO₃^– levels, the group mortality rate was 59.1% in the low HCO₃^– group and 19.8% in the high HCO₃^– group. Based on univariate analysis, six factors affecting mortality were identified. However, multivariate analysis showed that the levels of serum HCO₃^– (p = 0.013; OR: 0.552; CI: 0.345–0.882) and creatinine (p = 0.019; OR: 2.114; CI: 1.132–3.949) had an independent effect. Conclusion: In patients with COPD exacerbation and hypercapnia, the development of sufficient metabolic compensation and adequate renal function significantly decreases mortality.

Section: Discussionmentioning

confidence: 99%

Relationship of Metabolic Alkalosis, Azotemia and Morbidity in Patients with Chronic Obstructive Pulmonary Disease and Hypercapnia

Uçgun

Öztuna²,

Dagli³

et al. 2008

“…Ventilator-associated pneumonia (VAP) is the most frequent infectious complication among patients admitted to the intensive care unit (ICU), prolonging the length of stay at the ICU and increasing the risk of death in critically ill patients [1, 2. ]The attributable mortality rate appears to vary depending on the patient population and the infecting organism [3.]…”

Section: Introductionmentioning

confidence: 99%

Value of APACHE II, SOFA and CPIS Scores in Predicting Prognosis in Patients with Ventilator-Associated Pneumonia

Gürsel

Demirtas²

2006

Self Cite

Background: Ventilator-associated pneumonia (VAP) is the most frequent infection with high mortality rates in intensive care units (ICUs) and the prediction of outcome is important in the decision-making process. Objective: To assess the value of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Clinical Pulmonary Infection Score (CPIS) in the prediction of mortality during VAP episodes in pulmonary patients. Methods: This study was a prospective observational cohort study. Sixty-three patients who were admitted to the ICU and developed VAP were included in the study consecutively. Clinical and laboratory data conforming to the APACHE II and SOFA scores were recorded on admission and APACHE II, SOFA and CPIS scores on the day of the diagnosis of VAP. The outcome measure was the ICU mortality. Logistic regression and receiver operating characteristic (ROC) curve analyses and the area under the curve (AUC) were used to estimate the predictive ability of the scoring systems. Results: Mortality rate was 54%. The mean APACHE II (21 ± 6, 14 ± 5; p = 0.001), SOFA (7 ± 3, 4 ± 2; p = 0.002) and CPIS (8 ± 2, 7 ± 3; p = 0.025) scores determined at the time of VAP diagnosis were significantly higher in nonsurvivors than in survivors. Discrimination was excellent for APACHE II (ROC AUC: 0.81; p = 0.001) and acceptable for SOFA (ROC AUC: 0.71; p = 0.005) scores. Of the three scores only APACHE II >16 was an independent predictor of the mortality (OR: 5; 95% CI: 1.3–18; p = 0.019) in the logistic regression analysis. Conclusion: These results suggest that APACHE II determined at the time of VAP diagnosis may be useful in predicting mortality in the pulmonary ICU patient population who develops VAP.

“…In our study, there was no significant increase in the duration of mechanical ventilation. It is likely that some other factors may have more effect on the duration, for example ventilator-associated pneumonia or sepsis, as shown in a recent study [25]. …”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Characteristics and Outcomes of Patients with COPD Exacerbation with or without Venous Thromboembolism

Akgün

Meral

Önbaş³

et al. 2006

Background: Although some studies evaluated venous thromboembolism (VTE) prevalence in patients with chronic obstructive pulmonary disease (COPD), they contain no detailed description of the patients’ characteristics. Objectives: It was the aim of this study to investigate the frequency and clinical characteristics and outcomes of VTE in patients with COPD exacerbation. Methods: Between October 2004 and February 2005, 120 consecutive patients were included in the study. On admission, Doppler examination of lower extremities in all cases and spiral computed tomography of the thorax in cases with a suspicion of pulmonary thromboembolism were performed. A questionnaire was used to take a detailed history. In addition to routine laboratory tests, chest X-ray, postbronchodilator spirometry, arterial blood gas analysis and serum levels of D-dimer and C-reactive protein were evaluated, as well as dyspnea score and performance status before exacerbation. The hospitalization durations and mechanical ventilation requirements were also recorded. Results: VTE was determined in 16 cases (13.3%). In patients with VTE, the travel history was higher (p < 0.001), the dyspnea score worse (p = 0.005), the duration of hospitalization longer (p < 0.001) and the mechanical ventilation requirement increased (p < 0.001); a change in mental status was highly associated with the presence of VTE (p < 0.001). Conclusions: It seems that VTE occurrence was higher in the presence of a risk factor causing immobility such as travel history and increased dyspnea. The cases with severe disease are more likely to have VTE. Preventive measures may be considered in such patients because their hospitalization stay and mechanical ventilation requirement are increased.