Prognosis of patients with COPD admitted to the ICU.

摘要

We read with interest the article by Wildman a al} They have carried out an interesting study on patients with chronic obstructive pulmonary disease (COPD) or asthma admitted to the Intensive Care Unit (ICU). The authors in their discussion state that their overall results may be least applicable to patients on long-term oxygen (LTO) and/or with low functional scores. Intubated patients with COPD on LTO constitute 10.4% of 394 intubated patients in this study. Only mortality results relating to this population are shown in this article. It would have been interesting to show results such as quality of life at 180 days. If deciding to intubate is difficult in patients with exacerbated COPD, it is more difficult in those patients on LTO. Clinicians tend to be pessimistic about survival and quality of life and they are very selective when admitting these patients. In 1999 we reported on a study2 which focused on patients with exacerbated COPD on LTO who were mechanically ventilated. Mortality was higher than that reported by Wildman a al in this subgroup of patients: 35% (in ICU), 50% (in hospital), 75% (at 1 year) and 85% (at 5 years). Patients who died in hospital and in the first year after discharge had a lower forced expiratory volume in 1 s (FEVj) than survivors. Although the study was carried out in a University tertiary hospital, the sample size was small (20 patients recruited in 2 years).