Korean J Intern Med.  2006 Mar;21(1):1-9. 10.3904/kjim.2006.21.1.1.

Is Hypercapnea a Predictor of Better Survival in the Patients who Underwent Mechanical Ventilation for Chronic Obstructive Pulmonary Disease (COPD)?

• Park JH
• Koh Y
• Lim CM
• Hong SB
• Oh YM
• Shim TS
• Lee SD
• Kim WS
• Kim DS
• Kim WD

• KMID: 1782244
• DOI: http://doi.org/10.3904/kjim.2006.21.1.1

Abstract

BACKGROUND: There are contradictory reports concerning hypercapnia as a predictor of a better outcome in COPD. This study examined the clinical implications of hypercapnea in COPD patients (M:F = 59:19) who required mechanical ventilation. METHODS: The clinical parameters at the time of MICU admission, the total ventilation time, the APACHE II score and the pulmonary function testing were retrospectively analyzed between the survivors and nonsurvivors. RESULTS: Univariate analysis showed that compared with the nonsurvivors, the survivors had lower AaDO2 values (59.8+/-53.5 vs. 105.0+/-73.3 mmHg, p=0.000), higher PaCO2 values (64.9+/-16.0 vs. 48.9+/-17.8 mmHg, p=0.000), lower APACHE II scores (19.0+/-3.8 vs. 24.1+/-5.1, p=0.002), the more frequent application of initial noninvasive positive pressure ventilation (44.0 vs. 14.3%, p=0.008), and a lower combined rate of septic shock (4.0 vs. 39.3%, p=0.000). Multivariate analysis revealed that a lower PaCO2 (OR: 0.94, p=0.008), the presence of septic shock (OR: 10.16, p=0.011), a higher APACHE II score (OR: 1.22, p=0.040) and a longer ventilation time (OR: 1.002, p=0.041) were the risk factors for mortality. A lower PaCO2 was also verified as the predictor for mortality by multivariate analysis when excluding septic shock. CONCLUSIONS: Hypercapnia at admission is thought to be an independent predictor of better survival for the COPD patients who require mechanical ventilation.

Keyword

COPD; Hypercapnia; Mechanical ventilation; Respiratory failure; Mortality

MeSH Terms

*Treatment Outcome
Survival Analysis
Risk Factors
Retrospective Studies
Respiratory Insufficiency
*Respiration, Artificial/methods
Pulmonary Disease, Chronic Obstructive/*mortality/therapy
Prognosis
Patient Admission
Multivariate Analysis
Male
*Hypercapnia
Humans
Female
Biological Markers
Aged
APACHE