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.
Añón
J M
JM
Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain. elizalde@iponet.es
García de Lorenzo
A
A
Zarazaga
A
A
Gómez-Tello
V
V
Garrido
G
G
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