Abstract
Objectives. To investigate the effect of the cause of acute respiratory failure and the role of comorbidities both acute and chronic on the outcome of COPD patients admitted to Respiratory Intensive Care Unit (RICU) with acute respiratory failure and treated with NIV. Design. Observational prospective study. Patients and Methods. 176 COPD patients consecutively admitted to our RICU over a period of 3 years and treated with NIV were evaluated. In all patients demographic, clinical, and functional parameters were recorded including the cause of acute respiratory failure, SAPS II score, Charlson comorbidity index, and further comorbidities not listed in the Charlson index. NIV success was defined as clinical improvement leading to discharge to regular ward, while exitus or need for endotracheal intubation was considered failure. Results. NIV outcome was successful in 134 patients while 42 underwent failure. Univariate analysis showed significantly higher SAP II score, Charlson index, prevalence of pneumonia, and lower serum albumin level in the failure group. Multivariate analysis confirmed a significant predictive value for pneumonia and albumin. Conclusions. The most important determinants of NIV outcome in COPD patients are the presence of pneumonia and the level of serum albumin as an indicator of the patient nutritional status.
Highlights
Patients with acute respiratory acidosis caused by an exacerbation of chronic obstructive pulmonary disease (COPD) are the group that benefits most from noninvasive ventilation [1]
321 had COPD with acute or acute on chronic respiratory failure; the remaining 229 cases included patients without COPD and with respiratory failure caused by different conditions; 15 patients intolerant to NIV in the first hour of treatment were excluded from data analysis; 49 patients required oxygen therapy alone, while 81 required invasive ventilation
Causes of death in those patients were cardiogenic pulmonary edema (7), pneumonia (12), sepsis (8), atrial or ventricular arrhythmia (11), myocardial infarction (2), intestinal occlusion (1), pneumothorax (1), and lung cancer (2)
Summary
Patients with acute respiratory acidosis caused by an exacerbation of chronic obstructive pulmonary disease (COPD) are the group that benefits most from noninvasive ventilation [1]. “Real life” observational studies, performed outside specific RCTs, have shown on average a higher percentage of NIV failure than those performed in selected population [3, 4]. A recent study pointed out that COPD is not very often a “stand-alone” disease since comorbidities are frequent and 12 of them negatively influence the 4-year survival [8]. Whether the presence of chronic comorbidities could influence the short-term mortality and the NIV success during an acute exacerbation of COPD was only partially investigated.
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