Predictors of outcome for patients with COPD requiring invasive mechanical ventilation

被引:156
作者
Nevins, ML [1 ]
Epstein, SE [1 ]
机构
[1] Tufts Univ, New England Med Ctr, Div Pulm & Crit Care, Sch Med, Boston, MA 02111 USA
关键词
COPD; extubation; mechanical ventilation; outcomes analysis; weaning;
D O I
10.1378/chest.119.6.1840
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Introduction: Accurate outcomes data and predictors of outcomes are fundamental to the effective care of patients with COPD and in guiding them and their families through end-of-life decisions. Design: We conducted a retrospective cohort study of 166 patients using prospectively gathered data in patients with COPD who required mechanical ventilation for acute respiratory failure of diverse etiologies. Results: The in-hospital mortality rate for the entire cohort was 28% but fell to 12% for patients with a COPD exacerbation and without a comorbid illness. Univariate analysis showed a higher mortality rate among those patients who required > 72 h of mechanical ventilation (37% vs 16%; p < 0.01), those without previous episodes of mechanical ventilation (33% vs 11%; p < 0.01), and those with a failed extubation attempt (36% vs 7%; p = 0.0001). With multiple logistical regression, higher acute physiology score measured 6 h after the onset of mechanical ventilation, presence of malignancy, presence of APACHE (acute physiology and chronic health evaluation) II-associated comorbidity, and the need for mechanical ventilation greater than or equal to 72 h were independent predictors of poor outcome. Conclusions: We conclude that among variables available within the first 6 h of mechanical ventilation, the presence of comorbidity and a measure of the severity of the acute illness are predictors of in-hospital mortality among patients with COPD and acute respiratory failure. The occurrence of extubation failure or the need for mechanical ventilation beyond 72 h also portends a worse prognosis.
引用
收藏
页码:1840 / 1849
页数:10
相关论文
共 48 条
[41]  
SLUITER HJ, 1972, AM REV RESPIR DIS, V105, P932
[42]   OUTCOME AND FUNCTION FOLLOWING PROLONGED MECHANICAL VENTILATION [J].
SPICHER, JE ;
WHITE, DP .
ARCHIVES OF INTERNAL MEDICINE, 1987, 147 (03) :421-425
[43]   SURVIVAL FOLLOWING MECHANICAL VENTILATION FOR ACUTE RESPIRATORY-FAILURE IN ADULT MEN [J].
STAUFFER, JL ;
FAYTER, NA ;
GRAVES, B ;
CROMB, M ;
LYNCH, JC ;
GOEBEL, P .
CHEST, 1993, 104 (04) :1222-1229
[44]   INFLUENCE OF THE QUALITY OF NURSING ON THE DURATION OF WEANING FROM MECHANICAL VENTILATION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE [J].
THORENS, JB ;
KAELIN, RM ;
JOLLIET, P ;
CHEVROLET, JC .
CRITICAL CARE MEDICINE, 1995, 23 (11) :1807-1815
[45]  
VANDENBERGH E, 1968, AM REV RESPIR DIS, V98, P60
[46]   Non invasive mechanical ventilation in severe chronic obstructive lung disease and acute respiratory failure: Short and longterm prognosis [J].
Vitacca, M ;
Clini, E ;
Rubini, F ;
Nava, S ;
Foglio, K ;
Ambrosino, N .
INTENSIVE CARE MEDICINE, 1996, 22 (02) :94-100
[47]  
WARREN PM, 1980, LANCET, V1, P467
[48]   A PROSPECTIVE-STUDY OF INDEXES PREDICTING THE OUTCOME OF TRIALS OF WEANING FROM MECHANICAL VENTILATION [J].
YANG, KL ;
TOBIN, MJ .
NEW ENGLAND JOURNAL OF MEDICINE, 1991, 324 (21) :1445-1450