Abstract
The clinical implications of airflow limitation severity and blood eosinophil level in patients with chronic obstructive pulmonary disease (COPD) and prolonged mechanical ventilation (PMV) are unknown. Thus, this study aimed to identify whether or not these two indicators were significantly associated with short-term in-respiratory care center (RCC) treatment outcomes in this population. Of all participants (n = 181) in this retrospective cross-sectional study, 41.4%, 40.9%, 8.3%, and 52.5% had prolonged RCC admission (RCC length of stay >21 days), failed weaning, death, and any adverse outcomes of interest, respectively. Compared to participants without any adverse outcomes of interest, moderate (the Global Initiative for Chronic Obstructive Lung Disease (GOLD) II) and/or severe (GOLD III) airflow limitation were significantly associated with short-term in-RCC adverse outcomes in terms of failed weaning (for III versus I, OR = 15.06, p = 0.003) and having any adverse outcomes of interest (for II versus I, OR = 17.66, p = 0.002; for III versus I, OR = 37.07, p = 0.000) though the severity of airflow limitation did not have associations with prolonged RCC admission and death after adjustment. Meanwhile, blood eosinophilia defined by various cut-off values was not associated with any adverse outcomes. The findings have significant clinical implications and are useful in the management of patients with COPD and PMV.
Highlights
The number of patients requiring prolonged mechanical ventilation (PMV), generally defined as at least 14–21 days of continuous mechanical ventilation, is rapidly increasing worldwide due to an aging population, a greater number of co-morbidities and advances in critical care[1,2,3,4,5], leading to increased medical resource utilization and financial burden
To the best of our knowledge, only one previous study has explored factors associated with treatment outcomes in patients with chronic obstructive pulmonary disease (COPD) and PMV, which found that better long-term survival was associated with younger age, shorter length of stay in the intensive care unit (ICU) and the respiratory care center (RCC), and provision of maintenance non-invasive positive pressure ventilation after weaning[11]
Simple and multiple logistic regression analyses show a moderate and /or severe (GOLD III) airflow limitation were significantly associated with short-term in-RCC adverse outcomes in terms of failed weaning and having any adverse outcomes of interest, while blood eosinophilia defined by any cut-off value in this study was not associated with any short-term in-RCC adverse outcomes
Summary
The number of patients requiring prolonged mechanical ventilation (PMV), generally defined as at least 14–21 days of continuous mechanical ventilation, is rapidly increasing worldwide due to an aging population, a greater number of co-morbidities and advances in critical care[1,2,3,4,5], leading to increased medical resource utilization and financial burden. The presence of COPD, either as the cause of admission to an intensive care unit (ICU) or as a co-morbidity, is associated with PMV and has been shown to be an independent risk factor for mortality in both critically ill patients and patients with PMV7,10. It has been shown that blood eosinophilia, defined as either >2% or >300 cells/μL, is associated with a higher risk of exacerbations in patients with stable COPD14. This transition relocates these two indicators in the management of COPD. Whether or not the severity of airflow limitation and blood eosinophil level are significant risk factors for treatment outcomes in patients with COPD and PMV remains unknown
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