Predictors of invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

Abstract

Background: Standard treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with hypercapnic respiratory failure (HRF) includes bronchodilators, corticosteroids, antibiotics, suplemental oxygen and noninvasive ventilation (NIV) when needed. The rate of NIV failure requiring invasive mechanical ventilation (IMV) in critical AECOPD patients may be up to 63% (Squadrone E. et al. Intensive Care Med 2004;30:1303–1310). Specific markers for identification of patients at high risk for respiratory failure progression despite appropriate therapy, which would consequentially lead to IMV are still not well defined. The aim of the study was to identify those factors. Methods: 62 patients (40 man), mean age 68.4 (±10.4) years, admitted to respiratory intensive care unit due to AECOPD presenting with HRF were included in the study. Patients were treated with bronchodilatators, corticosteroids, antibiotics, suplemental oxygen, NIV as appropriate. Results: 14 patients had to be invasively mechanically ventilated. No significant difference was found among the patients needed IMV and those who didn’t for arterial blood gasses on admission. IMV group had significantly lower red blood cell count, hemoglobin and hematocrit (p Conclusion: Anemia, hypoalbuminemia, higher white blood cell count and higher troponin T level have been found as significant prognostic factors for respiratory failure progression requiring IMV initiation. This data could help define patients who need the closest monitoring.