Outcomes of patients with COPD requring mechanical ventilation

Baik, Jae Joong; Kim, Sang Chul; Lee, Tae Hoon; Chung, Yeon Tae

Abstract

BACKGROUND
The decision to institute mechanical ventilation for patients with COPD is very difficult. The accurate informaiton regarding weaning success and long-term survival will improve communication with patients and family and enhance informed consent. The aims of this study are to describe outcomes and identify variables associated with survival for patients experiencing mechanical ventilation with an acute respiratory failure of COPD.
METHODS
The 53 cases of mechanical ventilation in the intensive care unit in the National Medical Center from 1989 to 1998 were included. Data were collected retrospectively from medical records. Weaning success rate and 3 month and 1 year survival rates were estimated. Factors associated with weaning success and survival were determined.
RESULTS
Weaning success was 55%. For success group with 29 cases, 3 months survival rate was 61% and 1 year survival rate 37%. APACHE II scores in weaning success group were significantly lower than those in the failure group. Factors such as age, sex, comorbid-illnes, previous steroid use, causes of respiratory failure, RVH or arrhythmia on EKG, serum albumin level, arterial blood pH, PaO2, PaCO2, FEV1, duration of mechanical ventilation and steroid use during mechanical ventilation were not associated with weaning success. Only age and serum albumin level were associated with 3 month and 1 year survival. No COPD patients of age more than 75 years and serum albumin level less than 3g/dl had survived at 1 year after weaning success.
CONCLUSION
While seaning success from mechanical ventilation can be predicted by APACHE IIscore in COPD patients, long-term outcomes of survivors may be influenced by nutritional status and age.