VENTILATION IN A BIRMINGHAM INTENSIVE-CARE UNIT 1993-1995 - OUTCOME FOR PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

The aims of the study were to look at information on which the decisio n to ventilate chronic obstructive pulmonary disease (COPD) patients a dmitted to an intensive care unit (ITU) was based (including whether t here was discussion with the patient, relatives and consultant), to id entify indicators of poor prognosis, and to assess the outcomes of ven tilation and functional capacity after discharge. A retrospective stud y of 27 months of admissions was carried out. The following variables were studied to see if they influenced prognosis: premorbid history, a dmission diagnosis, consultant involvement in the decision to transfer to ITU, admission chest radiograph, sputum bacteriology, arterial blo od gases, APACHE II scores, duration of ventilation and complications in ITU. In-hospital mortality, post-discharge mortality and length of hospital stay were recorded. Functional capacity after discharge was a ssessed from the hospital clinic records and from general practitioner s. Forty-six percent of case notes had inadequate premorbid informatio n and no documented discussion occurred in 66% of patients/relatives. Poor prognostic indicators were admissions after cardiorespiratory arr est, cases discussed with consultants regarding ITU transfer, previous therapy with long-term oral steroids, and developing renal or cardiac failure in ITU. APACHE II scores were higher in the group that died. There was 49% hospital mortality and 59% 1-year mortality. Fifty-three percent of survivors were dependent upon carers and housebound, and g eneral practitioners felt that 59% of survivors had a higher dependenc e on carers, a worse exercise tolerance and a poorer quality of life t han before admission. The decision to ventilate is often made with ina dequate background history, which could be sought from general practit ioners, hospital case notes and family. There is significant morbidity and mortality following ventilation. Further prospective studies are required to help select which COPD patients should be ventilated.