Obstructive Lung Diseases |

Chronic Obstructive Pulmonary Disease in Intensive Care: A Retrospective Analysis of 19 Years FREE TO VIEW

Ricardo Reis, MD; Margarida Dias, MD; Artur Vale, MD; Francisco Esteves, MD
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Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal

Chest. 2014;145(3_MeetingAbstracts):423A. doi:10.1378/chest.1824961
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SESSION TYPE: Slide Presentations

PRESENTED ON: Monday, March 24, 2014 at 09:00 AM - 10:00 AM

PURPOSE: Epidemiologic characterization of ICU admissions of patients with exacerbation of COPD, review and comparison of severity scores with the remaining ICU admissions and analysis of prognostic factors for mortality and complications.

METHODS: Retrospective analysis of the patients admitted in the UCI of our Hospital Center in the period of January 1993 to December 2011. Statistical significance was assumed with p<0.05.

RESULTS: In the study period there were 495 admissions with exacerbation of COPD (9,4% of admissions), with a significant reduction in the number of admissions per year (Pearson’s r: -0.66). COPD admitted patients, were older (68.4 + 11.1 years), more frequently of male sex (68,7%), had greater APACHE II (22.6 + 7.5), longer mechanical ventilation time (5.5 + 6.3 days) and longer ICU stay (7.1 + 6.8 days). When compared only with the overall admissions, COPD admissions also had greater SAPS II (44.6 + 15.1) and initial SOFA (7.35 + 3.4). However, COPD patients had inferior ICU mortality (10,3%) and, when only compared with medical admissions, their final ICU SOFA (4.1 + 3.4) and hospital mortality (23%) were actually significantly lower. There was no difference in rates of tracheostomy (9,5%) or ventilator associated pneumonia (3,3%). Mortality prognostic factors were greater APACHE II, SAPS II and initial SOFA scores. Patients needing tracheostomy had greater APACHE II and SAPS II scores.

CONCLUSIONS: There were 495 (9,4%) of ICU admissions with COPD exacerbations, with an annual reduction tendency. These patients had greater severity scores, longer mechanical ventilation and admission times but had lower ICU mortality and, when compared with medical ICU admissions, had lower final ICU SOFA scores and hospital mortality. In these patients, severity scores were a prognostic factor for ICU mortality and tracheostomy.

CLINICAL IMPLICATIONS: COPD admissions in ICU care have greater severity, longer mechanical ventilation and longer stay in the ICU than medical or overall ICU admissions, but show inferior mortality rates and similar complications rates.

DISCLOSURE: The following authors have nothing to disclose: Ricardo Reis, Margarida Dias, Artur Vale, Francisco Esteves

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