Determinants of the Length of Mechanical Ventilation in Patients with COPD in the Intensive Care UnitGursel G.
Department of Pulmonary Diseases, Gazi University School of Medicine, Ankara, Turkey
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Background: About 10% of the patients with chronic obstructive pulmonary disease (COPD) are at high risk for prolonged mechanical ventilation (MV >21 days), and mortality ranges from 55 to 78% in these patients. Objective: To determine the potential risk factors for MV over periods of 1, 2 and 3 weeks in patients with COPD. Patients and Method: The characteristics of patients during the stable period of their disease, on admission to the intensive care unit (ICU) and during the ICU stay were recorded prospectively and analyzed retrospectively for this study. t test, XXX2 test and logistic regression analysis were used for statistical analysis. Results: 86 patients with COPD requiring MV were included in the study. 73, 33, and 13% of the patients required MV longer than 1, 2 and 3 weeks, respectively. There were no significant relationships between the duration of MV and bronchiectasis or the presence of community-acquired pneumonia on admission, baseline pulmonary function test results or blood gas parameters on admission. Development of ventilator-associated pneumonia (VAP; odds ratio, OR: 6; 95% confidence interval, CI: 2–23, p = 0.011) and sepsis (OR: 10; 95% CI: 2–54, p = 0.007) were independent predictors for MV >7 days. VAP was still a risk factor for MV >15 days with an OR of 14 (95% CI: 3–66, p = 0.001). On the other hand MV >21 days was primarily determined by increasing age (OR: 1.2; 95% CI: 1–1.3, p = 0.042), severity of the disease on admission measured by APACHE II score (OR: 1.4; 95% CI: 1–1.7, p = 0.002) and albumin levels (OR: 0.10, 95% CI: 0.01–0.54, p = 0.007). Conclusion: Advanced age, severity of disease on admission and development of VAP during ICU stay are the main determinants of MV duration in patients with COPD.
© 2005 S. Karger AG, Basel
National Heart, Lung, and Blood Institute: Morbidity and Mortality: Chartbook on Cardiovascular, Lung, and Blood Diseases. US Department of Health and Human Services, Public Health Service. Bethesda, National Institutes of Health, 1998.
- Viegi G, Scognamiglio A, Baldacci S, Pistelli F, Carrozzi L: Epidemiology of chronic obstructive pulmonary disease (COPD). Respiration 2001;68:4–19.
- Moran J, Green JV, Homan SD, Leeson RJ, Leppard PI: Acute exacerbations of chronic obstructive pulmonary disease and mechanical ventilation: A reevaluation. Crit Care Med 1998;26:71–78.
- 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 lung disease. JAMA 1995;274:1852–1857.
- Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti C, Rauss A, Simonneau G, Benito S, Gasparetto A, Lemaire F, Isabey D, Harf A: Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995;333:817–822.
- Nevins ML, Epstein SK: Predictors of outcome for patients with COPD requiring invasive mechanical ventilation. Chest 2001;119:1840–1849.
- Menzies R, Gibbons W, Goldberg P: Determinants of weaning and survival among patients with COPD who require mechanical ventilation for acute respiratory failure. Chest 1989;95:398–405.
- Nava S, Rubini F, Zanotti E, Ambrossino N, Bruschi C, Vitacca M, Fracchia C, Rampulla C: Survival and prediction of successful ventilator weaning in COPD patients requiring mechanical ventilation for more than 21 days. Eur Respir J 1994;7:1645–1652.
- Dasgupta A, Rice R, Mascha E, Litaker D, Stoller J: Four-year experience with a unit for long-term ventilation (respiratory special care unit) at the Cleveland Clinic Foundation. Chest 1999;116:447–455.
- Purro A, Appendini L, Gaetano A, Gudjonsdottir M, Donner CF, Rossi A: Physiologic determinants of ventilator dependence in long-term mechanically ventilated patients. Am J Respir Crit Care Med 2000;161:1115–1123.
American Thoracic Society: Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis 1987;136:225–244.
Global Initiative for Chronic Obstructive Lung Disease: Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease. NHLBI/WHO Workshop Report, updated 2003. Bethesda, National Heart, Lung and Blood Institute, 2001. www.goldcopd.com.
CDC definitions for nosocomial infections. Am Rev Respir Dis 1989;139:1058–1059.
- Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM: Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic ‘blind’ bronchoalveolar lavage fluid. Am Rev Respir Dis 1991;143:1121–1129.
- American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864–874.
- Heyland DK, Cook DJ, Griffith L, Keenan SP, Brun-Buisson C: The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. Am J Respir Crit Care Med 1999;159;1249–1256.
- O’Brien C, Guest PJ, Hill SL, Stockley RA: Physiological characterization of patients diagnosed with chronic obstructive pulmonary disease in primary care. Thorax 2000;55:635–642.
- Draculovic MB, Bauer TT, Torres A, Gonzales J, Rodrigez MH, Angrill J: Initial bacterial colonization in patients admitted to a respiratory intensive care unit: Bacteriological pattern and risk factors. Respiration 2001;68:58–66.
- Soler N, Torres A, Ewig S, Gonzales J, Celis R, El-Ebiary M, Hernandez C, Rodrigez-Roisin R: Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. Am J Respir Crit Care Med 1998;157:1498–1505.
- Cook DJ, Walter SD, Cook RJ, Griffith EL, Guyat GH, Leasa D, Jaeschke RZ, Brun-Buisson C, for the Canadian Critical Care Trials Group: Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998;129:433–440.
- Afessa B, Hogans L, Murfhy R: Predicting 3-day and 7-day outcomes of weaning from mechanical ventilation. Chest 1999;116:456–461.
Vuagnat A, Chastre J, Trouillet Jl, Benacerraf M, Conbaux D, Gibert C: Predicting prolonged (>14 days) duration of mechanical ventilation in ICU patients. The importance of disease and patient characteristics. Am J Respir Crit Care Med 1997;155:A768.
Marchese R, Macdonald L, Major M, Sutton D, Hyzy R, Popovch J: The utility of day seven APACHE III and APS in predicting the need for prolonged (>28 days) mechanical ventilation (abstract). Am J Respir Crit Care Med 1997;155:A768.
- Zilberberg MD, Epstein SK: Acute lung injury in the medical ICU: Co-morbid conditions, age, etiology, and hospital outcome. Am J Respir Crit Care Med 1998;157:1159–1164.
- Ely W, Evans G, Haponik E: Mechanical ventilation in a cohort of elderly patients admitted to an intensive care unit. Ann Intern Med 1999;131:96–104.
- Anon JM, Garcia de Lorenzo G, Zarazaga A, Gomez-Tello VG, 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;25:452–457.
- Ely EW, Bennett PA, Bowton DL, Murphy SM, Haponik EF: Large scale implementation of a respiratory therapist-driven protocol for ventilator weaning. Am J Respir Crit Care Med 1999;159:439–446.
- Kress JP, Pohlman AS, O’Connor MF, Hall JB: Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000;342:1471–1477.
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