Intensive Care Medicine

, Volume 30, Issue 9, pp 1747–1754 | Cite as

Co-morbidity and acute decompensations of COPD requiring non-invasive positive-pressure ventilation

  • Raffaele Scala
  • Sandra Bartolucci
  • Mario Naldi
  • Marcello Rossi
  • Mark W. Elliott
Original

Abstract

Objective

To assess the prevalence and the impact of chronic and/or acute non-respiratory co-morbidity on short and longer-term outcome of non-invasive positive pressure ventilation (NIPPV) in acute decompensations of chronic obstructive pulmonary disease (COPD) with acute hypercapnic respiratory failure (AHRF).

Design and setting

An observational study in a three-bed respiratory monitoring unit in a respiratory ward of a non-university hospital.

Patients

We grouped 120 consecutive COPD patients requiring NIPPV for AHRF (pH 7.28±0.05, PaO2/FIO2 ratio 192±63, PaCO2 78.3±12.3 mmHg) according to whether NIPPV succeeded (n=98) or failed (n=22) in avoiding the need for endotracheal intubation and whether alive (n=77) or dead (n=42) at 6 months.

Measurements and results

The prevalence of chronic and acute co-morbidity was, respectively, 20% and 41.7%; most of the cases were cardiovascular. In-hospital NIPPV failure was greater in patients with than in those without chronic (33.3% vs. 14.6%) or acute co-morbidity (32% vs. 8.6%). Six-month mortality was worse in patients with than in those without chronic (54.2% vs. 30.5%) or more than one acute co-morbidity (66.7% vs. 30.8%). Multiple regression analysis predicted in-hospital NIPPV failure by acute co-morbidity and forced expiratory volume in 1 s, while death at 6 months was predicted by having more than one acute co-morbidity, non-cardiovascular chronic co-morbidity and Activities of Daily Living score.

Conclusions

Chronic and acute co-morbidities are common in COPD patients with AHRF needing NIPPV and their presence influences short and longer-term outcome.

Keywords

Co-morbidities Chronic obstructive pulmonary disease Acute hypercapnic respiratory failure Non-invasive positive pressure ventilation Charlson index 

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Raffaele Scala
    • 1
  • Sandra Bartolucci
    • 2
  • Mario Naldi
    • 1
  • Marcello Rossi
    • 3
  • Mark W. Elliott
    • 4
  1. 1.U.O. Pneumologia, USL8Ospedale S. DonatoArezzoItaly
  2. 2.U.O. Sistema InformativoArezzoItaly
  3. 3.U.O. Fisiopatologia e Riabilitazione RespiratoriaAzienda Ospedaliera SeneseSienaItaly
  4. 4.Department of Respiratory MedicineSt. James’s University HospitalLeedsUK

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