Intensive care unit of Chest Department Zagazig University Hospitals’ experience in management of acute exacerbations of chronic obstructive pulmonary disease

Abstract

An acute exacerbation of chronic obstructive pulmonary disease (AECOPD) was responsible for 1.5 million emergency department visits, 726,000 hospitalizations, and approximately 119,000 deaths in 2000. THE AIM OF THE WORK To identify some factors that may influence outcome in patients with COPD exacerbations admitted to ICU to enable clinicians for better management in the future. PATIENT AND METHODS This study was carried out at the respiratory ICU of Chest Department Zagazig University Hospitals during the period from October 2008 to May 2010. One hundred COPD patients, admitted to ICU due to acute exacerbations of their illness, 42 with moderate exacerbations and 58 with sever exacerbations were included. Patients of the current study were classified according to initial planning of management into 3 groups. Group I included 20 patients indicated conservative treatment only. Group II included 20 patients indicated non-invasive ventilation (NIV) plus conservative treatment. Group III included 60 patients for whom invasive mechanical ventilation (IMV) was indicated plus conservative treatment. Assessment of the final outcome regarding: (a) death, (b) improvement and discharge without readmission within 1month of discharge, (c) improvement and discharge with readmission within 1month. RESULTS There was a significant difference among the three studied groups when compared regarding the duration of exacerbation, Glasgow coma scale, pulse rate, RR, level of total plasma proteins and serum albumin with worst parameters being in patients who indicated IMV. There was also a significant difference among the three studied groups on admission as regards pH, PaO2, PaCO2, HCO3, SO2 and serum potassium level with worst parameters in patients indicated invasive ventilation. The best outcome was in group I as 14 patients (70%) discharged without relapse within 1month and there were no deaths. CONCLUSION The overall ICU mortality and readmission rates were highly found in patients who indicated IMV. On the other hand the overall discharge rate without the need for readmission was noted to a great extent in patients who improved on conservative treatment only.