Mechanical ventilation of patients on long-term oxygen therapy with acute exacerbations of chronic obstructive pulmonary disease: prognosis and cost-utility analysis.
OBJECTIVE
To analyze the prognosis and costs of mechanical ventilation in patients with exacerbations of chronic obstructive pulmonary disease (COPD) treated with long-term oxygen therapy.


METHODS
A prospective cohort study. Follow-up at 1 and 5 years. Cost utility analysis.


METHODS
A medical-surgical intensive care unit (ICU) in a university hospital.


METHODS
20 patients with previous COPD treated with long-term oxygen therapy and needing mechanical ventilation due to acute respiratory failure.


RESULTS
Mortality in the ICU, in-hospital mortality (ICU plus ward), and mortality at 1 and 5 years, and factors associated with prognosis and cost-utility were assessed. The mean Acute Physiology and Chronic Health Evaluation II score was 20 (median 20 range 12-36). Cumulative mortality was 35% in the ICU, 50% in hospital, 75% at 1 year, and 85% at 5 years. Factors significantly associated with mortality in the ICU were low levels of albumin (p = 0.05) and sodium (p = 0.01) at admission. Patients who died in hospital and in the first year after discharge had a lower forced expiratory volume in 1 s (FEV1) than survivors (p = 0.03 and p = 0.05, respectively). The cost per Quality Adjusted Life Year (QALY) was U.S. $26283 and U.S. $44602 in a "best" (cost/QALY calculated for the life expectancy in Spain) and a "worst case scenario" (cost/QALY calculated for a 68-year life expectancy), respectively.


CONCLUSIONS
Applying mechanical ventilation to COPD patients treated with long-term oxygen therapy carries a high mortality and cost. Factors significantly associated with mortality in the ICU were albumin and sodium concentrations and FEV1 in hospital and in the first year after discharge.
Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain. elizalde@iponet.es
J M
JM
Añón
A
A
García de Lorenzo
A
A
Zarazaga
V
V
Gómez-Tello
G
G
Garrido
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D011379:Prognosis; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D012121:Respiration, Artificial / Q000191:economics / Q000401:mortality; D013030:Spain / Q000453:epidemiology; D018709:Statistics, Nonparametric; D015996:Survival Rate