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Intensive Care Medicine

, Volume 25, Issue 5, pp 452–457 | Cite as

Mechanical ventilation of patients on long-term oxygen therapy with acute exacerbations of chronic obstructive pulmonary disease: prognosis and cost-utility analysis

  • J. M. Añón
  • A. García de Lorenzo
  • A. Zarazaga
  • V. Gómez-Tello
  • G. Garrido
ORIGINAL

Astract

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. Design: A prospective cohort study. Follow-up at 1 and 5 years. Cost utility analysis. Setting: A medical-surgical intensive care unit (ICU) in a university hospital. Patients: 20 patients with previous COPD treated with long-term oxygen therapy and needing mechanical ventilation due to acute respiratory failure. Measurements and main 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. $ 26 283 and U. S. $ 44 602 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.

Key words Lung disease obstructive Long-term oxygen therapy Prognosis Quality of life Cost analysis 

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Copyright information

© Springer-Verlag Berlin Heidelberg 1999

Authors and Affiliations

  • J. M. Añón
    • 1
  • A. García de Lorenzo
    • 1
  • A. Zarazaga
    • 2
  • V. Gómez-Tello
    • 1
  • G. Garrido
    • 3
  1. 1.Intensive Care Unit, Hospital Universitario La Paz, Madrid, SpainES
  2. 2.Department of Surgery, Hospital Universitario La Paz, Madrid, SpainES
  3. 3.Investigation Unit, Hospital Universitario La Paz, Madrid, SpainES

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