Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-23T01:57:43.208Z Has data issue: false hasContentIssue false
  • English
  • Français

Arterial blood gas derangement and level of comorbidity are not predictors of long-term mortality of COPD patients treated with mechanical ventilation

Published online by Cambridge University Press:  01 July 2008

S. Christensen ,
L. Rasmussen ,
E. Horváth-Puhó ,
P. Lenler-Petersen ,
M. Rhode  and
S. P. Johnsen
S. Christensen*
Affiliation:
Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus C, Silkeborg, Denmark Silkeborg Hospital, Department of Anesthesiology and Intensive Care, Silkeborg, Denmark
L. Rasmussen
Affiliation:
Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus C, Silkeborg, Denmark Silkeborg Hospital, Department of Anesthesiology and Intensive Care, Silkeborg, Denmark
E. Horváth-Puhó
Affiliation:
Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus C, Silkeborg, Denmark
P. Lenler-Petersen
Affiliation:
Silkeborg Hospital, Department of Anesthesiology and Intensive Care, Silkeborg, Denmark
M. Rhode
Affiliation:
Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus C, Silkeborg, Denmark Silkeborg Hospital, Department of Anesthesiology and Intensive Care, Silkeborg, Denmark
S. P. Johnsen
Affiliation:
Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus C, Silkeborg, Denmark
*
Correspondence to: Steffen Christensen, Department of Clinical Epidemiology, Aarhus University Hospital, Ole Worms Alle 1150, 8000 Aarhus C, Denmark. E-mail: [email protected]; Tel: +45 8942 4820; Fax: +45 8942 4801
Get access

Summary

Background and objective

Limited and inconsistent data exist on simple, readily available predictors of long-term mortality of critically ill chronic obstructive pulmonary disease patients requiring invasive mechanical ventilation. We therefore examined the influence of arterial blood gas derangement and burden of comorbidities on 90-day and 1-yr mortality of chronic obstructive pulmonary disease patients treated with invasive mechanical ventilation.

Methods

We identified all chronic obstructive pulmonary disease patients (n = 230) treated with invasive mechanical ventilation between 1994 and 2004 at a Danish primary-level hospital. Data on arterial blood gas specimens and comorbidity were obtained from medical records and Hospital Discharge Registries. We used Cox’s regression analysis to estimate mortality ratios according to arterial blood gas values and level of comorbidity.

Results

Ninety-day and 1-yr mortality among chronic obstructive pulmonary disease patients requiring invasive mechanical ventilation was 30.8% and 40.5%, respectively. All 90-day and 1-yr mortality ratios according to arterial blood gas values were close to one and one was included in all 95% CI. Among patients with a high level of comorbidity 90-day mortality ratio was 1.3 (95% CI: 0.6–2.7) when compared with patients without comorbidity. The corresponding 1-yr mortality ratio was 1.4 (95% CI: 0.7–2.9).

Conclusion

Chronic obstructive pulmonary disease patients treated with invasive mechanical ventilation have substantial long-term mortality. Neither the levels of arterial blood gas values measured immediately before invasive mechanical ventilation was initiated nor the burden of comorbidity were strong determinants of long-term mortality among these patients.

Keywords

CHRONIC OBSTRUCTIVE PULMONARY DISEASEMORTALITYCRITICAL CAREMECHANICAL VENTILATION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 7 , July 2008 , pp. 550 - 556
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Hurd, S. The impact of COPD on lung health worldwide: epidemiology and incidence. Chest 2000; 117 (2 Suppl): 1S–4S.Google Scholar
2. Trends in chronic bronchitis and emphysema: Morbidity and mortality. Available at: http://www.lungusa.org/data/copd/copd1.pdf. Accessed 23 September 2007.Google Scholar
3.Needham, DM, Bronskill, SE, Sibbald, WJ, Pronovost, PJ, Laupacis, A. Mechanical ventilation in Ontario, 1992–2000: incidence, survival, and hospital bed utilization of noncardiac surgery adult patients. Crit Care Med 2004; 32 (7): 1504–1509.Google Scholar
4.Seneff, MG, Wagner, DP, Wagner, RP, Zimmerman, JE, Knaus, WA. Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. JAMA 1995; 274 (23): 1852–1857.Google Scholar
5.Connors, AF Jr, Dawson, NV, Thomas, C et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am J Respir Crit Care Med 1996; 154 (4 Pt 1): 959–967.CrossRefGoogle ScholarPubMed
6.Breen, D, Churches, T, Hawker, F, Torzillo, PJ. Acute respiratory failure secondary to chronic obstructive pulmonary disease treated in the intensive care unit: a long term follow up study. Thorax 2002; 57 (1): 29–33.CrossRefGoogle ScholarPubMed
7.Moran, JL, Green, JV, Homan, SD, Leeson, RJ, Leppard, PI. Acute exacerbations of chronic obstructive pulmonary disease and mechanical ventilation: a reevaluation. Crit Care Med 1998; 26 (1): 71–78.Google Scholar
8.Afessa, B, Morales, IJ, Scanlon, PD, Peters, SG. Prognostic factors, clinical course, and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure. Crit Care Med 2002; 30 (7): 1610–1615.Google Scholar
9.Anon, JM, Garcia de, LA, Zarazaga, A, Gomez-Tello, V, Garrido, G. Mechanical ventilation of patients on long-term oxygen therapy with acute exacerbations of chronic obstructive pulmonary disease: prognosis and cost-utility analysis. Intensive Care Med 1999; 25 (5): 452–457.Google Scholar
10.Nevins, ML, Epstein, SK. Predictors of outcome for patients with COPD requiring invasive mechanical ventilation. Chest 2001; 119 (6): 1840–1849.Google Scholar
11.Raurich, JM, Perez, J, Ibanez, J, Roig, S, Batle, S. In-hospital and 2-year survival of patients treated with mechanical ventilation for acute exacerbation of COPD. Arch Bronconeumol 2004; 40 (7): 295–300.Google Scholar
12.Rieves, RD, Bass, D, Carter, RR, Griffith, JE, Norman, JR. Severe COPD and acute respiratory failure. Correlates for survival at the time of tracheal intubation. Chest 1993; 104 (3): 854–860.Google Scholar
13.Portier, F, Defouilloy, C, Muir, JF. Determinants of immediate survival among chronic respiratory insufficiency patients admitted to an intensive care unit for acute respiratory failure. A prospective multicenter study. The French Task Group for Acute Respiratory Failure in Chronic Respiratory insufficiency. Chest 1992; 101 (1): 204–210.CrossRefGoogle Scholar
14.Hill, AT, Hopkinson, RB, Stableforth, DE. Ventilation in a Birmingham intensive care unit 1993–1995: outcome for patients with chronic obstructive pulmonary disease. Respir Med 1998; 92 (2): 156–161.CrossRefGoogle Scholar
15.Jeffrey, AA, Warren, PM, Flenley, DC. Acute hypercapnic respiratory failure in patients with chronic obstructive lung disease: risk factors and use of guidelines for management. Thorax 1992; 47 (1): 34–40.Google Scholar
16.Kaelin, RM, Assimacopoulos, A, Chevrolet, JC. Failure to predict six-month survival of patients with COPD requiring mechanical ventilation by analysis of simple indices. A prospective study. Chest 1987; 92 (6): 971–978.CrossRefGoogle ScholarPubMed
17.Ai-Ping, C, Lee, KH, Lim, TK. In-hospital and 5-year mortality of patients treated in the ICU for acute exacerbation of COPD: a retrospective study. Chest 2005; 128 (2): 518–524.CrossRefGoogle ScholarPubMed
18.Kizer, JR, Zisman, DA, Blumenthal, NP et al. Association between pulmonary fibrosis and coronary artery disease. Arch Intern Med 2004; 164 (5): 551–556.Google Scholar
19.Hole, DJ, Watt, GC, Davey-Smith, G, Hart, CL, Gillis, CR, Hawthorne, VM. Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study. BMJ 1996; 313 (7059): 711–715.CrossRefGoogle ScholarPubMed
20.Andersen, TF, Madsen, M, Jorgensen, J, Mellemkjoer, L, Olsen, JH. The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull 1999; 46 (3): 263–268.Google Scholar
21.Pauwels, RA, Buist, AS, Calverley, PM, Jenkins, CR, Hurd, SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001; 163 (5): 1256–1276.Google Scholar
22.de Groot, V, Beckerman, H, Lankhorst, GJ, Bouter, LM. How to measure comorbidity. A critical review of available methods. J Clin Epidemiol 2003; 56 (3): 221–229.Google Scholar
23.Royston, P, Altman, DG, Sauerbrei, W. Dichotomizing continuous predictors in multiple regression: a bad idea. Stat Med 2006; 25 (1): 127–141.CrossRefGoogle ScholarPubMed
24.Greenland, S. Dose-response and trend analysis in epidemiology: alternatives to categorical analysis. Epidemiology 1995; 6 (4): 356–365.Google Scholar
25.Royston, P, Ambler, G, Saurbrei, W. The use of Fractional Polynomials to model continuous risk variables in epidemiology. Int J Epidemiol 1999; 28: 964–974.Google Scholar
26.Ray, P, Birolleau, S, Lefort, Y et al. Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Crit Care 2006; 10: R82.Google Scholar
27.Poses, RM, McClish, DK, Smith, WR, Bekes, C, Scott, WE. Prediction of survival of critically ill patients by admission comorbidity. J Clin Epidemiol 1996; 49 (7): 743–747.CrossRefGoogle ScholarPubMed
28.Wildman, MJ, Sanderson, C, Groves, J et al. Implications of prognostic pessimism in patients with chronic obstructive pulmonary disease (COPD) or asthma admitted to intensive care in the UK within the COPD and asthma study (CAOS): multicentre observational cohort study. BMJ 2007; 335: 1132–1134.Google Scholar