Acute exacerbation of COPD requiring admission to the intensive care unit

The aim of this study was to summarize experiences of patients admitted to the intensive care unit (ICU) for an acute exacerbation of COPD and to identify factors associated with a poor outcome.

An observational case series of 102 consecutive admissions to the ICU for acute exacerbation of COPD between January 1998 and December 2002 were studied.

In total, 102 admissions to the ICU were reviewed. There were no ICU deaths but there were 18 hospital deaths (18%). A total of 28 patients were treated with non-invasive positive pressure ventilation (NIPPV), of whom four (14% failure rate) subsequently required intubation and mechanical ventilation (MV). Another 16 patients (16%) were successfully weaned from MV with NIPPV. Nine patients (9%), who had more than one episode of re-intubation after weaning (RAW), were from the mechanically ventilated group. Tracheostomy was performed for four patients (3.9%). The median duration of both NIPPV and MV was 1 day. The median length of stay in the ICU and hospital were 2 days (SD, 7.2) and 8 days (SD, 9.6), respectively. Univariate analysis identified serum total protein to be associated with hospital mortality (P = 0.004)

For patients with acute exacerbations of COPD in the ICU, serum total protein, a surrogate marker for nutrition, was significantly associated with hospital mortality.