Characteristics and outcome of COPD patients with an acute exacerbation admited to a respiratory ICU

Many patients with an acute exacerbation may be considered for ICU admission. The aim of this study was to assess the clinical charateristics, resource use and prognosis of COPD patients in a respiratory ICU setting (RICU). Methods: Retrospective study of RICU patients with primary diagnosis of COPD exacerbation from 1995-2007. We collected clinical information, ventilatory support requirements and outcome from the clnical records. Results: During the study period 512 COPD patients were admitted with a mean age of 69,2±8,9 yr (86% amle). Mean FEV1 was 34,8±13,9 (% predicted value) and 40,4% were on long term home oxygen. More than half of the patients had one or more significant co-morbidities. Cardiac disease (26%) and alcoholism (14%) were among the most frequently encountered. As much as 49,4% of cases required intubation and mechanical ventilation (MV) while 38,9% could be managed with non-invasive ventilation (NIV). Only 5,8% of the patients treated with NIV at admission required finally MV. The duration of MV was 7,13 days (median 5, IQ Range: 3-9 days) and the overall ICU length of stay was 7.1 days (median 4 days, IQ Range: 2-8 days). Tracheostomy was performed in 4,7% of the cases. Finnally, ICU mortality for all the study group was 9,4%. We did not find an association between mortality and FEV1 or being on home oxygen therapy. Conclusions: RICU mortality for COPD patients with acute exacerbation is lower than 10%. Most patients requiring MV could be extubated without major issues. A lower FEV1 or being on home oxygen were not associated with a higher RICU mortality. COPD patients admitted to the ICU with an acute exacerbation have a good chance of survival.