Long-term survival according to ventilation mode in acute respiratory failure secondary to chronic obstructive pulmonary disease: a multicenter, inception cohort study.
OBJECTIVE
The aim of the study was to investigate 5-year survival stratified by mechanical ventilation modality in chronic obstructive pulmonary disease (COPD) patients treated in the ICU.


METHODS
Prospective, observational study of COPD patients with acute respiratory failure admitted to 9 multidisciplinary ICUs in Sweden. Characteristics on admission, including illness severity scores and the first blood gas, and survival were analyzed stratified by ventilation modality (noninvasive [NIV] vs invasive mechanical ventilation).


RESULTS
Ninety-three patients, mean age of 70.6 (SD, 9.6) years, were included. Sixteen patients were intubated immediately, whereas 77 were started on NIV. Patients who were started on NIV had a lower median body mass index (BMI) (21.9 vs 27.0; P < .01) and were younger compared to those who were intubated immediately (median age, 70 vs 74.5 years; P < .05). There were no differences in the initial blood gas results between the groups. Long-term survival was greater in patients with NIV (P < .05, log rank). The effect of NIV on survival remained after including age, Acute Physiology and Chronic Health Evaluation II score, and BMI in a multivariate Cox regression model (NIV hazard ratio, 0.44; 95% confidence interval, 0.21-0.92). Fifteen patients with failed NIV were intubated and mechanically ventilated. Long-term survival in patients with failed NIV was not significantly different from patients who were intubated immediately.


CONCLUSIONS
The short-term survival benefit of NIV previously found in randomized controlled trials still applies after 5 years of observation.
Berkius
Johan
J
Department of Anesthesia and Intensive Care, Västervik Hospital, Västervik, Sweden. johanb@ltkalmar.se
Sundh
Josefin
J
Nilholm
Lennart
L
Fredrikson
Mats
M
Walther
Sten M
SM
D000367:Age Factors; D000368:Aged; D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality* / Q000628:therapy; D012121:Respiration, Artificial / Q000379:methods / Q000401:mortality*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality*; D016019:Survival Analysis; D013548:Sweden; D016896:Treatment Outcome