SESSION TITLE: End of Life Care Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: To analyze the intubation and invasive mechanical ventilation (IMV) related decision-making process and the prognosis of Chinese patients with chronic obstructive pulmonary disease (COPD) receiving IMV.
METHODS: We retrospectively analyzed all patients received IMV solely because of exacerbation of COPD from June 2003 to June 2011. Baseline clinical parameters, indications for intubation, intubation decision makers, timing of informed consent and clinical outcomes were recorded. Patients survived the first intubation were followed up until December 2012 to complete Kaplan-Meier survival analysis.
RESULTS: Of all the 115 COPD patients received IMV for nonoperational purposes, 66 cases were excluded to focus on patients received IMV solely because of exacerbation of COPD. For the 57 intubation incidents of the remaining 49 patients, all the informed consent was signed by a surrogate family member. None of the informed consent was a direct reflection of the will of patient himself/herself. 73.7%(42) of the informed consent was signed within 24 hours before intubation, despite a 29 days median duration of hospitalization before intubation for the group. Two patients asked to withdraw mechanical ventilation after regained consciousness. In our study group, 50.9% patients were extubated successfully; 45.6% survived to hospital discharge; median duration of mechanical ventilation was 8 days, while 18.4% were supported by mechanical ventilation for more than 30 days, with maximum ventilation duration approaching 245 days. The median survival time after intubation was 1.03 months; survival rates at 6 months and 1 year were 29.5% and 24.8% respectively. 12 patients confronted second intubation choice after surviving the first episode, and 7 of them refused to be reintubated.
CONCLUSIONS: In China, the choice of intubation and IMV for patients with advanced COPD did not reflect the will of patients themselves. The majority of the informed consent was obtained in a hasty manner shortly before intubation.
CLINICAL IMPLICATIONS: Better end-of-life (EOL) care communication might improve patient autonomy and avoid unwanted and prolonged mechanical ventilation for advanced COPD patients.
DISCLOSURE: The following authors have nothing to disclose: Xin Zhang, Xinyan Huang, Yukun Kuang, Zhiwen Zhu, Canmao Xie
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