Acute exacerbation of COPD requiring admission to the intensive care unit

Abstract

Objective: The aim of this study was to summarize experiences of patients admitted to the intensive care unit (ICU) for an acute exacerbation of COPD and to identify factors associated with a poor outcome.

Methodology: An observational case series of 102 consecutive admissions to the ICU for acute exacerbation of COPD between January 1998 and December 2002 were studied.

Results: In total, 102 admissions to the ICU were reviewed. There were no ICU deaths but there were 18 hospital deaths (18%). A total of 28 patients were treated with non-invasive positive pressure ventilation (NIPPV), of whom four (14% failure rate) subsequently required intubation and mechanical ventilation (MV). Another 16 patients (16%) were successfully weaned from MV with NIPPV. Nine patients (9%), who had more than one episode of re-intubation after weaning (RAW), were from the mechanically ventilated group. Tracheostomy was performed for four patients (3.9%). The median duration of both NIPPV and MV was 1 day. The median length of stay in the ICU and hospital were 2 days (SD, 7.2) and 8 days (SD, 9.6), respectively. Univariate analysis identified serum total protein to be associated with hospital mortality (P = 0.004)

Conclusion: For patients with acute exacerbations of COPD in the ICU, serum total protein, a surrogate marker for nutrition, was significantly associated with hospital mortality.