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Clinical Investigations in Critical Care |

Hypercapnic Respiratory Failure in COPD Patients*: Response To Therapy

Guy W. Soo Hoo, MD, FCCP; Navid Hakimian, MD; Silverio M. Santiago, MD, FCCP
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*From the Pulmonary and Critical Care Section, West Los Angeles VAMC and UCLA School of Medicine, Los Angeles, CA.

Correspondence to: Guy W. Soo Hoo, MD, FCCP, Pulmonary and Critical Care Section (111Q), West Los Angeles VAMC, 11301 Wilshire Blvd, Los Angeles, CA 90073; e-mail: Guy.Soohoo@med.va.gov



Chest. 2000;117(1):169-177. doi:10.1378/chest.117.1.169
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Introduction: The clinical course of patients with acute exacerbations of underlying COPD presenting with hypercapnic respiratory failure was reviewed.

Methods: This was a retrospective review of 138 episodes of hypercapnic respiratory failure (Paco2 ≥ 50 mm Hg and pH ≤ 7.35). Patients were admitted to the West Los Angeles VAMC Medical Intensive Care Unit between 1990 and 1994.

Results: Of the 138 hypercapnic episodes, 74 (54%) required intubation. Comparison was made with the 64 cases in which patients responded to medical therapy. Patients requiring intubation had a greater severity of illness, with a higher APACHE II (Acute Physiology and Chronic Health Evaluation II) score (18 ± 5 vs 16 ± 4; p < 0.01), higher WBC, higher serum BUN, and greater acidosis (pH, 7.26 ± 0.07 vs 7.28 ± 0.06; p = 0.08). Those with the most severe acidosis (pH < 7.20) had the highest intubation rate (70%) and shortest time to intubation (2 ± 2 h), and they required the longest period of time to respond to medical therapy (69 ± 60 h). With an initial pH of < 7.25, there was a consistently higher intubation rate. Conversely, those with an initial pH of 7.31 to 7.35 were less likely to be intubated (45%), had a longer time to intubation (13 ± 18 h), and had a more rapid response to medical therapy (30 ± 18 h). Of those patients requiring intubation, most (78%) were intubated within 8 h of presentation, and the vast majority (93%) by 24 h. Of those patients responding to medical therapy, half (52%) recovered within 24 h and the vast majority (92%) recovered within 72 h.

Conclusions: This study provides a better characterization of the response to therapy of COPD patients with hypercapnic respiratory failure. This should be useful in limiting or omitting medical therapy in high-risk patients, thereby avoiding delays in intubation as well as providing a framework for continued therapy in those more likely to improve.

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