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Published in: Intensive Care Medicine 9/2004

01-09-2004 | Original

Co-morbidity and acute decompensations of COPD requiring non-invasive positive-pressure ventilation

Authors: Raffaele Scala, Sandra Bartolucci, Mario Naldi, Marcello Rossi, Mark W. Elliott

Published in: Intensive Care Medicine | Issue 9/2004

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Abstract

Objective

To assess the prevalence and the impact of chronic and/or acute non-respiratory co-morbidity on short and longer-term outcome of non-invasive positive pressure ventilation (NIPPV) in acute decompensations of chronic obstructive pulmonary disease (COPD) with acute hypercapnic respiratory failure (AHRF).

Design and setting

An observational study in a three-bed respiratory monitoring unit in a respiratory ward of a non-university hospital.

Patients

We grouped 120 consecutive COPD patients requiring NIPPV for AHRF (pH 7.28±0.05, PaO2/FIO2 ratio 192±63, PaCO2 78.3±12.3 mmHg) according to whether NIPPV succeeded (n=98) or failed (n=22) in avoiding the need for endotracheal intubation and whether alive (n=77) or dead (n=42) at 6 months.

Measurements and results

The prevalence of chronic and acute co-morbidity was, respectively, 20% and 41.7%; most of the cases were cardiovascular. In-hospital NIPPV failure was greater in patients with than in those without chronic (33.3% vs. 14.6%) or acute co-morbidity (32% vs. 8.6%). Six-month mortality was worse in patients with than in those without chronic (54.2% vs. 30.5%) or more than one acute co-morbidity (66.7% vs. 30.8%). Multiple regression analysis predicted in-hospital NIPPV failure by acute co-morbidity and forced expiratory volume in 1 s, while death at 6 months was predicted by having more than one acute co-morbidity, non-cardiovascular chronic co-morbidity and Activities of Daily Living score.

Conclusions

Chronic and acute co-morbidities are common in COPD patients with AHRF needing NIPPV and their presence influences short and longer-term outcome.
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Literature
1.
go back to reference Bott J, Carroll MP, Conway JH, Keilty SEJ, Ward EM, Brown AM, Paul EA, Elliott MW, Godfrey RC, Wedzicha JA, Moxham J (1993) Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet 341:1555–1557CrossRefPubMed Bott J, Carroll MP, Conway JH, Keilty SEJ, Ward EM, Brown AM, Paul EA, Elliott MW, Godfrey RC, Wedzicha JA, Moxham J (1993) Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet 341:1555–1557CrossRefPubMed
2.
go back to reference Kramer N, Meyer J, Meharg J, Cece RD, Hill NS (1995) Randomised, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 151:1799–1806PubMed Kramer N, Meyer J, Meharg J, Cece RD, Hill NS (1995) Randomised, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 151:1799–1806PubMed
3.
go back to reference Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, Simonneau G, Benito S, Gasparetto A, Lemaire F, Isabey D, Harf A (1995) Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 333:817–822CrossRefPubMed Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, Simonneau G, Benito S, Gasparetto A, Lemaire F, Isabey D, Harf A (1995) Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 333:817–822CrossRefPubMed
4.
go back to reference Celikel T, Sungur M, Ceyhan B, Karakurt S (1998) Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure. Chest 114:1636–1642PubMed Celikel T, Sungur M, Ceyhan B, Karakurt S (1998) Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure. Chest 114:1636–1642PubMed
5.
go back to reference Plant PK, Owen JL, Elliott MW (2000) Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards. A multicenter randomised controlled trial. Lancet 355:1931–1935CrossRefPubMed Plant PK, Owen JL, Elliott MW (2000) Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards. A multicenter randomised controlled trial. Lancet 355:1931–1935CrossRefPubMed
6.
go back to reference Lightowler JVJ, Elliott MW (2000) Predicting the outcome from NIV for acute exacerbations of COPD. Thorax 55:815–816CrossRefPubMed Lightowler JVJ, Elliott MW (2000) Predicting the outcome from NIV for acute exacerbations of COPD. Thorax 55:815–816CrossRefPubMed
7.
go back to reference Ambrosino N, Foglio K, Rubini F, Clini E, Nava S, Vitacca M (1995) Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success. Thorax 50:750–757PubMed Ambrosino N, Foglio K, Rubini F, Clini E, Nava S, Vitacca M (1995) Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success. Thorax 50:750–757PubMed
8.
go back to reference Antón A, Güel R, Gómez J, Serrano J, Castellano A, Carrasco JL, Sanchis J (2000) Predicting the results of noninvasive ventilation in severe acute exacerbations of patients with chronic airflow limitation. Chest 117:823–833 Antón A, Güel R, Gómez J, Serrano J, Castellano A, Carrasco JL, Sanchis J (2000) Predicting the results of noninvasive ventilation in severe acute exacerbations of patients with chronic airflow limitation. Chest 117:823–833
9.
go back to reference Plant PK, Owen JL, Elliott MW (2001) Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome. Thorax 56:708–712CrossRefPubMed Plant PK, Owen JL, Elliott MW (2001) Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome. Thorax 56:708–712CrossRefPubMed
10.
go back to reference Fuso L, Antonelli Incalzi R, Pistelli R, Muzzolon R, Valente S, Pagliari G, Gliozzi F, Ciappi G (1995) Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease. Am J Med 98:272–277CrossRefPubMed Fuso L, Antonelli Incalzi R, Pistelli R, Muzzolon R, Valente S, Pagliari G, Gliozzi F, Ciappi G (1995) Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease. Am J Med 98:272–277CrossRefPubMed
11.
go back to reference Antonelli Incalzi R, Fuso L, De Rosa M, Forastiere F, Rapiti E, Nardecchia B, Pistelli R (1997) Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J 10:2794–2800CrossRefPubMed Antonelli Incalzi R, Fuso L, De Rosa M, Forastiere F, Rapiti E, Nardecchia B, Pistelli R (1997) Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J 10:2794–2800CrossRefPubMed
12.
go back to reference Moretti M, Cilione C, Tampieri A, Fracchia C, Marchioni A, Nava S (2000) Incidence and causes of non-invasive mechanical ventilation failure after initial success. Thorax 55:819–825CrossRefPubMed Moretti M, Cilione C, Tampieri A, Fracchia C, Marchioni A, Nava S (2000) Incidence and causes of non-invasive mechanical ventilation failure after initial success. Thorax 55:819–825CrossRefPubMed
13.
go back to reference Confalonieri M, Gorini M, Ambrosino N, Mollica C, Corrado A (2001) Respiratory intensive care units in Italy: a national census and prospective cohort study. Thorax 5:373–378CrossRef Confalonieri M, Gorini M, Ambrosino N, Mollica C, Corrado A (2001) Respiratory intensive care units in Italy: a national census and prospective cohort study. Thorax 5:373–378CrossRef
14.
go back to reference Manen JG van, Bindels PJE, IJzermans CJ, van der Zee JS, Bottema BJAM, Schadé E (2001) Prevalence of comorbidity in patients with a chronic airways obstruction and controls over the age of 40. J Clin Epidemiol 54:287–293CrossRefPubMed Manen JG van, Bindels PJE, IJzermans CJ, van der Zee JS, Bottema BJAM, Schadé E (2001) Prevalence of comorbidity in patients with a chronic airways obstruction and controls over the age of 40. J Clin Epidemiol 54:287–293CrossRefPubMed
15.
go back to reference Miravitlles M, Guerrero T, Mayordomo C, Sànchez-Agudo L, Nicolau F, Segù JL (2000) Factors associated with increased risk of exacerbation and hospital admission in a cohort of ambulatory COPD patients: a multiple logistic regression analysis. Respiration 67:495–501CrossRefPubMed Miravitlles M, Guerrero T, Mayordomo C, Sànchez-Agudo L, Nicolau F, Segù JL (2000) Factors associated with increased risk of exacerbation and hospital admission in a cohort of ambulatory COPD patients: a multiple logistic regression analysis. Respiration 67:495–501CrossRefPubMed
16.
go back to reference Nevins ML, Epstein SK (2001) Predictors of outcome for patients with COPD requiring invasive mechanical ventilation. Chest 119:1840–1849CrossRefPubMed Nevins ML, Epstein SK (2001) Predictors of outcome for patients with COPD requiring invasive mechanical ventilation. Chest 119:1840–1849CrossRefPubMed
17.
go back to reference Dewan N, Rafique S, Kamwar B, Satpathy H, Ryschon K, Tillotson GS, Niederman MS (2000) Acute exacerbation of COPD. Factors associated with poor treatment outcome. Chest 117:662–671CrossRefPubMed Dewan N, Rafique S, Kamwar B, Satpathy H, Ryschon K, Tillotson GS, Niederman MS (2000) Acute exacerbation of COPD. Factors associated with poor treatment outcome. Chest 117:662–671CrossRefPubMed
18.
go back to reference Connors AF, Dawson NV, Thomas C, Harrell FE, Desbiens N, Fulkerson WJ, Kussin P, Bellamy P, Goldman L, Knaus WA (1996) Outcomes following acute exacerbation of severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 154:959–967PubMed Connors AF, Dawson NV, Thomas C, Harrell FE, Desbiens N, Fulkerson WJ, Kussin P, Bellamy P, Goldman L, Knaus WA (1996) Outcomes following acute exacerbation of severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 154:959–967PubMed
19.
go back to reference Seneff MG, Wagner DP, Wagner RP, Zimmerman JE, Knaus WA (1995) Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. JAMA 274:1852–1857CrossRefPubMed Seneff MG, Wagner DP, Wagner RP, Zimmerman JE, Knaus WA (1995) Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. JAMA 274:1852–1857CrossRefPubMed
20.
go back to reference Afessa B, Morales IJ, Scanlon PD, Peters SG (2002) Prognostic factors, clinical course, and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure. Crit Care Med 30:1610–1615CrossRefPubMed Afessa B, Morales IJ, Scanlon PD, Peters SG (2002) Prognostic factors, clinical course, and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure. Crit Care Med 30:1610–1615CrossRefPubMed
21.
go back to reference Scala R, Bartolucci S, Archinucci I, Coniglio G, Naldi M, Rossi M (2002) Non-respiratory comorbidity and prognosis of non invasive positive pressure mechanical ventilation in acute hypercapnic respiratory failure due to COPD exacerbations. Eur Respir J 20 [Suppl 38]:281 Scala R, Bartolucci S, Archinucci I, Coniglio G, Naldi M, Rossi M (2002) Non-respiratory comorbidity and prognosis of non invasive positive pressure mechanical ventilation in acute hypercapnic respiratory failure due to COPD exacerbations. Eur Respir J 20 [Suppl 38]:281
22.
go back to reference European Respiratory Society Task Force on epidemiology of respiratory intermediate care in Europe (2002) Respiratory intermediate care units: a European survey. Eur Respir J 20:1343–1350CrossRefPubMed European Respiratory Society Task Force on epidemiology of respiratory intermediate care in Europe (2002) Respiratory intermediate care units: a European survey. Eur Respir J 20:1343–1350CrossRefPubMed
23.
go back to reference Ferguson GT, Gilmartin M (1995) CO2 rebreathing during BiPAP ventilatory assistance. Am J Respir Crit Care Med 151:1126–1135PubMed Ferguson GT, Gilmartin M (1995) CO2 rebreathing during BiPAP ventilatory assistance. Am J Respir Crit Care Med 151:1126–1135PubMed
24.
go back to reference Kelly BJ, Matthay HD (1993) Prevalence and severity of neurological dysfunction in critically ill patients. Influence on need for continued mechanical ventilation. Chest 104:1818–1824PubMed Kelly BJ, Matthay HD (1993) Prevalence and severity of neurological dysfunction in critically ill patients. Influence on need for continued mechanical ventilation. Chest 104:1818–1824PubMed
25.
go back to reference Charlson ME, Pompei P, Ales KL, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMed Charlson ME, Pompei P, Ales KL, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMed
26.
go back to reference Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, Sirio CA, Murphy DJ, Lotring T, Damiano A, Harrell FE (1991) The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalised adults. Chest 100:1619–1936PubMed Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, Sirio CA, Murphy DJ, Lotring T, Damiano A, Harrell FE (1991) The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalised adults. Chest 100:1619–1936PubMed
27.
go back to reference Katz MH. Multivariable analysis: a primer for readers of medical research (2003) Ann Intern Med 138:644–650PubMed Katz MH. Multivariable analysis: a primer for readers of medical research (2003) Ann Intern Med 138:644–650PubMed
28.
go back to reference Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley, New York Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley, New York
29.
go back to reference Menzies R, Gibbons W, Goldberg P (1989) Determinants of weaning and survival among patients with COPD who require mechanical ventilation for acute respiratory failure. Chest 95:398–405PubMed Menzies R, Gibbons W, Goldberg P (1989) Determinants of weaning and survival among patients with COPD who require mechanical ventilation for acute respiratory failure. Chest 95:398–405PubMed
30.
go back to reference Confalonieri M, Parigi P, Scartabellati A, Aiolfi S, Scorsetti S, Nava S, Gandola L (1996) Noninvasive mechanical ventilation improves the immediate and long-term outcome of COPD patients with acute respiratory failure. Eur Respir J 9:422–430CrossRefPubMed Confalonieri M, Parigi P, Scartabellati A, Aiolfi S, Scorsetti S, Nava S, Gandola L (1996) Noninvasive mechanical ventilation improves the immediate and long-term outcome of COPD patients with acute respiratory failure. Eur Respir J 9:422–430CrossRefPubMed
31.
go back to reference Bardi G, Pierotello R, Desideri M, Valdisserri L, Bottai M, Palla A (2000) Nasal ventilation in COPD exacerbations: early and late results of a prospective, controlled study. Eur Respir J 15:98–104PubMed Bardi G, Pierotello R, Desideri M, Valdisserri L, Bottai M, Palla A (2000) Nasal ventilation in COPD exacerbations: early and late results of a prospective, controlled study. Eur Respir J 15:98–104PubMed
32.
go back to reference Vitacca M, Clini E, Rubini F, Nava S, Foglio K, Ambrosino N (1996) Non-invasive mechanical ventilation in severe chronic obstructive lung disease and acute respiratory failure: short- and long-term prognosis. Intensive Care Med 22:94–100PubMed Vitacca M, Clini E, Rubini F, Nava S, Foglio K, Ambrosino N (1996) Non-invasive mechanical ventilation in severe chronic obstructive lung disease and acute respiratory failure: short- and long-term prognosis. Intensive Care Med 22:94–100PubMed
Metadata
Title
Co-morbidity and acute decompensations of COPD requiring non-invasive positive-pressure ventilation
Authors
Raffaele Scala
Sandra Bartolucci
Mario Naldi
Marcello Rossi
Mark W. Elliott
Publication date
01-09-2004
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 9/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-004-2368-4

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