Long term survival in chronic obstructive pulmonary disease after ventilation in intensive care

Objective To compare the one year survival after discharge from ICU of patients with chronic obstructive pulmonary disease (COPD) admitted for acute hypercapnic respiratory failure and who required mechanical ventilation. Methods Retrospective cohort study on 130 patients, 52 patients were treated with non-invasive ventilation (NIV) and 78 patients with conventional mechanical ventilation (CMV). Results In 73 patients the cause for respiratory failure could not be identified. Long-term survival was significantly better following NIV than with CMV (p = 0.02 by log-rank testing), but the better prognosis associated with use of NIV was not found in patients with no documented cause for the respiratory failure. After adjusting for male gender, age >65 years, simplified acute physiology score 11 >35, prior long-term home oxygen therapy, treatment with steroids, FEV1<30% of predicted value, body-mass index <21 kg/m(2), albumin level <30 g/L, right ventricular failure, ventilator-associated pneumonia and cause of respiratory failure, NIV remained independently associated with better outcomes (adjusted hazard ratio 0.55; 95% Cl 0.31-0.97; p = 0.04). Conclusions Our results suggest that in COPD patients requiring mechanical ventilation and who survived after an ICU stay, the use of NIV is an independent factor associated with a better long-term survival, especially in those with a documented cause of respiratory failure.