Case mix and outcomes for admissions to UK adult, general critical care units with chronic obstructive pulmonary disease: a secondary analysis of the ICNARC Case Mix Programme Database

Martin J Wildman,Anthony R Brady,David A Harrison,Kathy Rowan

doi:10.1186/cc3719

Abstract

IntroductionChronic obstructive pulmonary disease (COPD) is a common cause of admission to intensive care units (ICUs) in the UK. This report describes the case mix and outcomes of these patients and explores associations of measures of case mix available in the first 24 hours with outcome.MethodWe conducted a secondary analysis of a high quality clinical database, the ICNARC Case Mix Programme Database, of 129,647 admissions to 128 adult, general critical care units across England, Wales and Northern Ireland for the period from 1995 to 2001.ResultsNonsurgical admissions with COPD accounted for 3752 admissions (2.9% of all admissions). Patients were acidotic (median pH 7.26, interquartile range [IQR] 7.18–7.33), hypercapnic (median arterial CO2 tension 8.7, IQR 6.9–10.7) and hypoxic (median arterial O2 tension/fractional inspired oxygen gradient 22.9, IQR 17.2–29.6). Overall, 2775 (73.9%) were definitely intubated and 278 (7.4%) were probably intubated in the first 24 hours in the ICU. The median (IQR) ICU length of stay was 4.0 (1.6–9.4) days and the hospital length of stay was 16 (9–29) days. a total of 827 patients (23.1%) died in the admitting ICU and 1322 (38.3%) died during hospital admission. Age, presence of severe respiratory disease, length of stay in hospital before critical care admission, cardiopulmonary resuscitation within 24 hours before admission, intubation status in first 24 hours in critical care, pH, arterial oxygen tension/fractional inspired oxygen gradient, albumin, cardiovascular organ failure, neurological organ failure and renal organ failure all had independent associations with hospital mortality. Respiratory organ failure had a significant independent association with decreased hospital mortality.ConclusionNonsurgical patients with COPD represent an important group of patients admitted to UK ICUs. The presence of single organ respiratory failure in the first 24 hours in critical care identifies patients with a 70% chance of surviving to leave hospital.

Highlights

Chronic obstructive pulmonary disease (COPD) is a common cause of admission to intensive care units (ICUs) in the UK
Nonsurgical patients with COPD represent an important group of patients admitted to UK ICUs
A recent UK study [3] suggested that clinicians involved in the emergency care of COPD patients had made a median of 10 intensive care unit (ICU) gatekeeping decisions for COPD patients in the preceding 12 months

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a common cause of admission to intensive care units (ICUs) in the UK. The prevalence of chronic obstructive pulmonary disease (COPD) in the UK has been estimated to be 1%, increasing to 5% in men aged 65–74 years and 10% in men older than 75 years [1]. COPD accounted for more than 100,000 hospital admissions in England in 2000/2001 and is the fifth most common cause of mortality in the UK, with 30,000 deaths each year [2]. ADL = activities of daily living; APACHE = Acute Physiology and Chronic Health Evaluation; CI = confidence interval; CMP = Case Mix Programme; CMPD = Case Mix Programme Database; COPD = chronic obstructive pulmonary disease; FiO2 = fractional inspired oxygen; ICU = intensive care unit; IQR = interquartile range; PaO2 = arterial oxygen tension.

Methods

Results

Discussion

Conclusion