ICU characteristics of patients with chronic respiratory failure during acute exacerbations

Introduction

Pathophysiology of respiratory failure in COPD is highly different from other diseases caused chronic respiratory failure. Respiratory muscle dysfunction detoriated by dynamic hyperinflation, malnutrition and electrolyte disturbances is major contributor to weaning failure and prolonged mechanical ventilation in these patients. The aim of this study is to investigate if there is any difference in patients' characteristics in ICU between COPD and nonCOPD diseases caused chronic respiratory failure and require mechanical ventilation during acute exacerbations.

Method

Forty-six patients with chronic respiratory failure and acute exacerbation were included in the study. Twenty-eight of them had COPD (group 1) and 18 patients had chronic respiratory failure caused by nonCOPD diseases (group 2) (Bronchiectasia [3], asthma [3], diffuse interstitial fibrosis [6], neuromuscular diseases [6]). All patients required mechanical ventilation.

Results

Patients' characteristics assesed in this study are given in the Table. Noninvasive mechanical ventilation (NIMV) were tried in 56% of patients in group 1 and 48% of patients in group 2. 58% of patients in group 1 and 40% of patients in group 2 were taking long term O₂ therapy. Patients with COPD were significantly older and had significantly higher APACH II scores than group 2. Their blood phosphorus level were significantly lower than group 2. In COPD patients duration of mechanical ventilation and requirement of tracheostomy were significantly lower than group 2. While there was no significant difference between Pseudomonas infections between the groups, ventilator associated pneumonia (VAP) caused by Acinetobacter species in group 1 significantly lower than group 2. There was no significant differences between the groups in hospital mortality rates, length of ICU and hospital stay and sepsis rates.

Table

Conclusion

These results showed that there might be some differences in weaning process and ICU infections between COPD and nonCOPD diseases in the ICU but they do not cause any significant difference in mortality, sepsis rates, and length of ICU and hospital stay.