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Epidemiological Characteristics and Outcomes of Patients With Severe COPD Requiring Mechanical Ventilation FREE TO VIEW

Shruti Gadre; Abhijit Duggal; Jorge Guzman
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Cleveland Clinic Foundation, Cleveland, OH

Chest. 2014;146(4_MeetingAbstracts):58A. doi:10.1378/chest.1991911
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SESSION TITLE: COPD 30-Day Readmission

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 28, 2014 at 11:00 AM - 12:15 PM

PURPOSE: There is limited data on the epidemiologic characteristics and outcomes of patients with severe COPD requiring invasive mechanical ventilation. The prognosis of acute respiratory failure requiring invasive mechanical ventilation is believed to be grim in this population. The purpose of this study was to illustrate the epidemiologic characteristics and outcomes of patients with severe COPD requiring mechanical ventilation.

METHODS: Retrospective study of patients admitted to a quaternary referral medical intensive care unit between January 2008 and December 2012 with a diagnosis of severe COPD (based on clinical history & chronic hypercapnea/hypoxia) and requiring invasive mechanical ventilation for acute respiratory failure.

RESULTS: We evaluated 677 patients with an established diagnosis of severe COPD who were mechanically ventilated over the study period. 47% were males, and the mean age was 63.7±12.4 years. 122 (17.9%) were given a trial of NIPPV prior to IPPV. 456 (67.35%) were intubated because of a respiratory etiology, but of these only n=73 (16%) had a primary diagnosis of COPD exacerbation as the cause of intubation. Non-pulmonary causes of admission were rare. The median duration of mechanical ventilation was 3 days (IQR 2-7). Duration of ICU stay was 4.9 days (IQR 2.3-9.3). 165 (24.4%) patients died in the ICU. ICU mortality for COPD exacerbation was lower than patients admitted for other reasons (16.4% vs 25.1%). Ultimately, 69.9% patients survived the hospitalization of which 25.2% patients were discharged home while the reminder went to LTAC or SNF. The median duration of hospitalization was 12.5 days (IQR 7- 21.6). 123 (18.16%) (n=123) patients were readmitted for respiratory failure requiring mechanical ventilation during the study period. The mean number of readmissions for these patients was 1.69± 1.3 episodes. There was a higher rate of readmission (30.13 vs 16.7%) in patients where COPD exacerbation was identified as the primary diagnosis at each admission.

CONCLUSIONS: Overall survival in patients with severe COPD undergoing mechanical ventilation is similar to other groups of patients undergoing mechanical ventilation described in the literature.

CLINICAL IMPLICATIONS: Patients with severe COPD have a favorable ICU survival after mechanical ventilation for acute respiratory failure. These patients have a similar rate of failure of non-invasive mechanical ventilation, and share overall functional outcomes with previous descriptions of mechanically ventilated patients with critical illness.

DISCLOSURE: The following authors have nothing to disclose: Shruti Gadre, Abhijit Duggal, Jorge Guzman

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