Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide and results in an economic and social burden. Acute respiratory failure (ARE) may develop in patients with COPD as a result of any condition that increases the work of breathing and decreases the respiratory drive. Objective: To describe COPD patients follow up in intensive care unit (ICU) to predict outcome and to compare prognostic factors in survivors and non survivors with acute respiratory failure. Subjects and methods: 30 COPD patients with acute respiratory failure (23 males and 7 females) admitted to intensive care unit in Benha university hospital and classified according to their outcome to two groups: Survivor group: 21 patients (16 male and 5 females with mean age 63.1417.094), all had conventional treatment with 5 patients succeeded from NIV and 5 patients succeeded from IMV applied in first day of ICU admission. Non survivor group: 9 patients. All had IMV in the first day of ICU admission and two of them had NW in the first day of ICU admission with failure outcome where they converted to IMV in the first day of ICU admission. In ICU, X-ray, ABC, Nat K+, liver and kidney functions, ECG, assessment of exacerbation severity, assessment of Glasgow scale and APACHE H Score were all done. Out of thirty, eight patients received NW plus conventional treatment, of which three patients failed and needed to be intubated and
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide and results in an economic and social burden. Acute respiratory failure (ARE) may develop in patients with COPD as a result of any condition that increases the work of breathing and decreases the respiratory drive. Such conditions include: 1) Respiratory tract infection such as bronchitis or pneumonia. 2) Central nervous system (CNS) depression as head trauma or injudicious use of sedatives, opioids, tranquilizers, or oxygen (02). 3) Cardiovascular disorders as myocardial infarction, heart failure, or pulmonary emboli. 4) Airway irritants as
Chest and Internal Medicine *Departments, Faculty of Medicine, Benha University.
to receive IMV, while thirteen patients received IMV plus conventional treatment as they were not candidate for NIV from the start. Results: There was a statistically significant difference (p value <0.05) between survivors and non survivors groups as regard previous history of ICU admission and of MV with higher tendency of non survivors for ICU admission and receive MV. There was a statistically significant difference as regard pulse (HR), respiratory rate, serum creatinine, APACHE II which were higher in non survivor group and M.A.P, GCS, serum sodium and albumin, pH of ABC which were lower in non survivor group. The mean length of ICU stay was longer in survivors group (4.6713.44) when compared with non-survivors group (2.22±2.224) and was of significant difference in predicting ICU outcome. Good outcome was obtained when NIV was used. The ICU mortality rate was calculated as 30%of all patients and about 46.66% of all patients underwent MV and all non survivors were mechanically ventilated. Mortality rate in the mechanically ventilated patients was 64.3%. Conclusion: Previous ICU admission and previous history of MV may predict the need for IMV in COPD patients with acute respiratory failure admitted to ICU. Higher heart rate, Respiratory rate, serum creatinine, APACHE II score and low mean arterial pressure, serum sodium, serum albumin, pH (acidosis) and low GCS as well as less hospital and ICU length of stay may predict increased ICU mortality |
