Decompensation of Chronic Obstructive Pulmonary Disease in Intensive Care: About 30 Cases

Abstract

Summary: Chronic obstructive pulmonary disease is a slowly progressive chronic respiratory disease linked to smoking. Its evolution is marked by decompensation that can be life-threatening for the patient and thus require hospitalization in intensive care. The aim of our work is to describe the therapeutic management of patients hospitalized for decompensation of COPD and their clinical and etiological characteristics. The patients were all chronic smokers in 80% of cases with an average age of 62 years. Exacerbations were of infectious etiology in 76% with 43% bronchial superinfections and 33% pneumonia, and without identified cause in 15% of cases. Our patients were staged according to the GOLD classification. Stage 4 patients represented 63%, 56% had right heart failure and developed more exacerbations per year (4 on average) resulting in more hospitalization in intensive care (3 on average) while stage 3 patients represented 36% of all patients. Drug treatment was dominated by antibiotics, bronchodilators and corticosteroids. 80% of patients were on oxygen, 20% of whom were on long-term oxygen therapy. Ventilatory assistance was considered in 26% by means of non-invasive ventilation (NIV) and 16% required endotracheal intubation. In conclusion, decompensation of COPD alters the quality of life of patients and worsens the prognosis of COPD. According to the experience of our service, many therapeutic behaviors have been initiated by following international recommendations even if they remain controversial. However, a great effort is necessary, especially concerning the fight against tobacco.