[Long term survival in chronic obstructive pulmonary disease after ventilation in intensive care].
OBJECTIVE
To compare the one year survival after discharge from ICU of patients with chronic obstructive pulmonary disease (COPD) admitted for acute hypercapnic respiratory failure and who required mechanical ventilation.


METHODS
Retrospective cohort study on 130 patients, 52 patients were treated with non-invasive ventilation (NIV) and 78 patients with conventional mechanical ventilation (CMV).


RESULTS
In 73 patients the cause for respiratory failure could not be identified. Long-term survival was significantly better following NIV than with CMV (p=0.02 by log-rank testing), but the better prognosis associated with use of NIV was not found in patients with no documented cause for the respiratory failure. After adjusting for male gender, age>65 years, simplified acute physiology score II>35, prior long-term home oxygen therapy, treatment with steroids, FEV1<30% of predicted value, body-mass index<21 kg/m2, albumin level<30 g/L, right ventricular failure, ventilator-associated pneumonia and cause of respiratory failure, NIV remained independently associated with better outcomes (adjusted hazard ratio 0.55; 95% CI 0.31-0.97; p=0.04).


CONCLUSIONS
Our results suggest that in COPD patients requiring mechanical ventilation and who survived after an ICU stay, the use of NIV is an independent factor associated with a better long-term survival, especially in those with a documented cause of respiratory failure.
Service des Maladies infectieuses et réanimation médicale, Hôpital Pontchaillou, CHU de Rennes, Université de Rennes 1, Rennes, France. arnaud.gacouin@chu-rennes.fr
A
A
Gacouin
G
G
Leveiller
T
T
Guy
S
S
Salomon
S
S
Isslame
I
I
Jouannic
P
P
Delaval
Y
Y
Le Tulzo
D000368:Aged; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies