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Observational Study
. 2023 Jun 1;51(6):753-764.
doi: 10.1097/CCM.0000000000005807. Epub 2023 Feb 15.

Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease in the ICU: An Observational Study From the OUTCOMEREA Database, 1997-2018

Louis-Marie Galerneau  1   2 , Sébastien Bailly  2 , Nicolas Terzi  1   2 , Stéphane Ruckly  3 , Maité Garrouste-Orgeas  4 , Yves Cohen  5 , Vivien Hong Tuan Ha  6 , Marc Gainnier  7 , Shidasp Siami  8 , Claire Dupuis  9 , Michael Darmon  10 , Jean-Marie Forel  11 , Guillaume Rigault  1 , Christophe Adrie  12 , Dany Goldgran-Toledano  13 , Virginie Laurent  14 , Etienne de Montmollin  15   16 , Laurent Argaud  17 , Jean Reignier  18 , Jean-Louis Pepin  2 , Jean-François Timsit  15   16 ; OUTCOMEREA Network
Affiliations
Observational Study

Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease in the ICU: An Observational Study From the OUTCOMEREA Database, 1997-2018

Louis-Marie Galerneau et al. Crit Care Med. .

Abstract

Objectives: Our aim was to describe changes in the management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) by ICUs and patient outcomes.

Design: We extracted data from the OutcomeRea database concerning patients admitted for AECOPD between 1997 and 2018. We analyzed trends in the use of ventilatory support, corticosteroid therapy, antibiotic therapy, and patient survival.

Setting: ICUs at 32 French sites.

Patients: One thousand eight hundred sixteen patients in the database had a diagnosis of AECOPD.

Interventions: None.

Measurements and main results: Over time, there was a reduction in the prescription of corticosteroids and antibiotics. In a time-series analysis, these changes in practice were not linked with ICU mortality. The proportion of patients treated with invasive mechanical ventilation (IMV) also gradually declined (from 51% between 1997 and 2002 to 35% between 2013 and 2018) with an association between decrease in IMV use and reduction in ICU mortality in a time series analysis. Rates of noninvasive ventilation (NIV) failure decreased with an increase in NIV use to support weaning from IMV. There was a reduction in the median ICU length of stay (from 8 d in 1997-2002 to 4 d in 2013-2018) and in the median total duration of hospitalization (from 23 d in 1997-2002 to 14 d in 2013-2018). We observed an improvement in prognosis, with decreases in overall hospital mortality (from 24% between 1997 and 2002 to 15% between 2013 and 2018), ICU mortality (from 14% between 1997 and 2002 to 10% between 2013 and 2018), and 90-day mortality (from 41% between 1997 and 2002 to 22% between 2013 and 2018).

Conclusions: The length of stay and mortality of patients with AECOPD admitted to ICUs has decreased over the last 20 years, with a wider use of NIV and a reduction in antibiotic and corticosteroid prescriptions.

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Conflict of interest statement

Dr. Terzi received funding from Pfizer for attending meetings and/or travel. Dr. Hong Tuan Ha disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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