2007 Outcomes of Patients Treated in Intensive Care Settings for Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Dr Grace SM Lam
Department of Medicine, Pamela Youde Nethersole Eastern Hospital
Background
Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a common cause of emergency admission. A better knowledge of possible outcomes after invasive treatment is important to making rational decisions.
Method
Patients admitted to the Medical High Dependency Unit (MHDU) or Intensive Care Unit (ICU) of Pamela Youde Nethersole Eastern Hospital for acute exacerbations of COPD from January 2000 to December 2005 were analyzed retrospectively.
Results
Of the 499 index admissions identified, 428 were excluded and 71 were analysed. The median (IQR) hospital length of stay was 17 (9-34) days. Twenty-seven (38%) patients died in hospital and the median (IQR) time from hospital admission to hospital death was 60 (15-162) days. Coexisting congestive heart failure and low body weight were independent predictors of hospital death. Forty-four patients survived their index admission. Among them, 26 (59%) died after a median of 1202 (367-1732) days from hospital discharge. The overall mortality from index admission till the time of data collection was 74.6% and the median (IQR) survival was 386 (17-1640) days. Low activity level, need of invasive mechanical ventilation, and coexisting ulcer disease were independent predictors of overall mortality. Independence in activities of daily living (ADL) and activity level deteriorated significantly in survivors after hospital discharge.
Conclusions
Patients admitted to intensive care units for severe COPD exacerbations suffered high hospital and longer-term mortality. Survivors deteriorated in ADL dependency and activity level. This information could be taken into consideration in the management of similar patients.
