Obstructive Lung Diseases |

Characteristics, Managements, and Outcomes of Patients Hospitalized to Intensive Care Unit With an Acute Exacerbation of COPD in US 2008-2012 FREE TO VIEW

Mihaela Stefan, MD; Brian Nathanson, PhD; Steingrub Jay, MD; Higgins Thomas, MD; Tara Lagu, MD; Michael Rothberg, MD; Lindenauer Peter, MD
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Baystate Medical Center, Springfield, MA

Chest. 2014;145(3_MeetingAbstracts):382A. doi:10.1378/chest.1825442
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SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Patients with severe acute exacerbation of COPD (AE-COPD) may require admission to the intensive care unit (ICU) but there is little recent data describing these patients in US hospitals.

METHODS: Analysis of prospectively collected data during 2008-2012 on 3,520 ICU patients age 40 or older with AE-COPD from 38 US hospitals

RESULTS: The median age was 67. 45.7% were male, and 89.6% were full code. Overall, 45.5% were invasively mechanically ventilated (IMV) and 29.6% noninvasively ventilated (NIV), with the average (SD) days on IMV being 4.0 (6.0). Hospital and ICU mortality were 11.1% and 6.5% respectively but varied among subgroups. Patients admitted directly to the ICU (52.1%) had lower mortality than those transferred from other hospitals (18.3%) or from the hospital ward (mortality = 8.2% vs 10.2% vs 16.9% respectively, p<0.001). Patients older than 75 had higher ICU and hospital mortality than those under 65 (10.6 % vs 14.2 % and 18.7% vs 6.9%, p<0.001) and were more likely discharged to hospice (7.9% vs 2.7%). NIV use did not vary by age but older patients were significantly less likely to receive IMV. There was no difference in hospital mortality among teaching versus non-teaching hospitals though patients at teaching hospitals had higher IMV rates (47.6% vs 38.3%, p<0.001) and greater acuity (median Acute Physiology Score 37 vs 35, p<0.001). From 2008 to 2012, the use of NIV increased from 17.6% to 42.3% (p<0.001) with more modest decreases in IMV use and hospital mortality.

CONCLUSIONS: Critically ill patients with AE-COPD have a mortality rate of 11.1% and are more likely to receive IMV than NIV, though NIV use is increasing. Patient management, particularly the use of IMV, varied by age, acuity, prior location, and the teaching status of the hospital

CLINICAL IMPLICATIONS: The management of AE-COPD in the ICU varies considerably. Hospital mortality may decrease if more consistent protocols are implemented to best treat these patients.

DISCLOSURE: The following authors have nothing to disclose: Mihaela Stefan, Brian Nathanson, Steingrub Jay, Higgins Thomas, Tara Lagu, Michael Rothberg, Lindenauer Peter

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