Outcome of patients admitted to respiratory intensive care unit with acute exacerbation of chronic obstructive lung disease

Background
Chronic obstructive pulmonary disease (COPD) is now the third leading cause of death in the United States, and its rising mortality trend is unique among the top 5 causes of death.


Aim
Was to evaluate the outcome of patients admitted to respiratory intensive care unit (ICU) with acute exacerbation of COPD (AECOPD) and to compare different methods of management.


Patients and methods
This prospective study was carried out on 83 patients (57 males and 26 females) admitted to respiratory ICU, Chest Department, Sohag University Hospitals during the period from September 2019 to July 2020. All patients were subjected to complete history taking, clinical examination, and routine laboratory investigation. Patients also were subjected to chest radiographs, ECG, and echocardiography, modified Allen test was performed to ensure adequate collateral circulation from ulnar artery. Patients were divided into two groups: noninvasive ventilation (NIV) group (n=59) and invasive mechanical ventilation (IMV) (n=24).


Results
There was a statistical difference between the two groups as regards the duration of ICU stay, which was higher in IMV group with mean of 9.92 ± 4.84 days versus 4.69 ± 1.55 days in NIV group (P≤0.0001), and the need for tracheostomy which was higher in IMV group with six (25.00%) patients versus four (6.78%) in NIV group (P=0.03). Occurrences of complications after weaning were statistically higher in the IMV group, with 14 (58.33%) patients versus 16 (27.12%) in the NIV group (P=0.007).


Conclusion
Creatinine, K, and pneumonia in radiograph, computed tomography, or sonar were significant independent predictors of mortality in AECOPD. Glasgow coma scale, K, and pneumonia in radiograph were significant independent predictors of occurrence of complications in AECOPD. Hypertension, admission pulse, admission temperature and IMV versus NIV were significant independent factors affecting duration of ICU stay in AECOPD.