The influence of community-acquired pneumonia to the clinical course in COPD cases admitted to intensive care unit with acute respiratory failure

Gungor G., Mocin O. Y., Acarturk E., Basbug Y., Salturk C., YALÇINSOY M., ...Daha Fazla

TUBERKULOZ VE TORAK-TUBERCULOSIS AND THORAX, cilt.58, sa.4, ss.408-417, 2010 (ESCI) identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 58 Sayı: 4
  • Basım Tarihi: 2010
  • Dergi Adı: TUBERKULOZ VE TORAK-TUBERCULOSIS AND THORAX
  • Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, TR DİZİN (ULAKBİM)
  • Sayfa Sayıları: ss.408-417
  • Anahtar Kelimeler: Community-acquired pneumonia, intensive care unit, chronic obstructive pulmonary disease, OBSTRUCTIVE PULMONARY-DISEASE, VENTILATOR-ASSOCIATED PNEUMONIA, ACUTE EXACERBATIONS, NONINVASIVE VENTILATION, MECHANICAL VENTILATION, MORTALITY, RISK, SEVERITY, IMPACT, ICU
  • İnönü Üniversitesi Adresli: Hayır

Özet

In this study the influence of community-acquired pneumonia to the clinical course in 173 COPD patients admitted to ICU with acute respiratory failure (ARF) was evaluated. In prospective descriptive study, patients with pneumonia at admission to ICU were grouped as Group 1, others Group 2. The demographics, "Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II" scores, body mass index (BMI), comorbidities, steroid use, admission arterial blood gases (ABG), leucocyte and CRP, utilization and duration of non-invasive and invasive mechanical ventilation (NIMV and IMV), development of ventilator associated pneumonia (VAP) and septic shock, length of stay (LOS) in ICU and mortality of groups were recorded and compared. No differences were found between demographics, but leucocyte and CRP levels were determined higher in Group 1(p= 005, 0.001). NIMV, IMV ratio and IMV days are similar (respectively p= 0.419, 0.170, 0.459); NIMV was applied longer in Group 2 (p= 0.019). 4 (17.6%) patients in group 1 and 7 (6.3%) patients in Group 2 were switched to IMV(p= 0.083) due to NIMV failure. While VAP was detected in 8 (17.7%) cases of intubated 45 (26%) patients, rate of VAP was similar in both groups (p= 0.657). 2 (6.7%) patients in Group 1 and 12 (8.3%) patients in Group 2 died and no difference was found in terms of LOS in ICU. Mortality was found 3 times higher (26.7%) than overall mortality (8.1%) in patients with IMV. Mortality risk factors are higher CRP levels (p< 0.016, OR: 1.01 CI 95%: 1.00-1.02), NIMV application determined to reduce the mortality. In conclusions, the presence of pneumonia, on admission to ICU in COPD patients with ARF, didn't influence IMV duration, LOS and mortality in ICU. Although mortality can be higher in COPD patients with high CRP levels, but NIMV is thought to be a mortality reducing treatment approach.