Document Detail

Hypercapnic respiratory failure in COPD patients: response to therapy.
MedLine Citation:
PMID:  10631216     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: The clinical course of patients with acute exacerbations of underlying COPD presenting with hypercapnic respiratory failure was reviewed. METHODS: This was a retrospective review of 138 episodes of hypercapnic respiratory failure (PaCO(2) > or = 50 mm Hg and pH < or = 7.35). Patients were admitted to the West Los Angeles VAMC Medical Intensive Care Unit between 1990 and 1994. RESULTS: Of the 138 hypercapnic episodes, 74 (54%) required intubation. Comparison was made with the 64 cases in which patients responded to medical therapy. Patients requiring intubation had a greater severity of illness, with a higher APACHE II (Acute Physiology and Chronic Health Evaluation II) score (18 +/- 5 vs 16 +/- 4; p < 0.01), higher WBC, higher serum BUN, and greater acidosis (pH, 7.26 +/- 0.07 vs 7.28 +/- 0.06; p = 0.08). Those with the most severe acidosis (pH < 7.20) had the highest intubation rate (70%) and shortest time to intubation (2 +/- 2 h), and they required the longest period of time to respond to medical therapy (69 +/- 60 h). With an initial pH of < 7.25, there was a consistently higher intubation rate. Conversely, those with an initial pH of 7.31 to 7. 35 were less likely to be intubated (45%), had a longer time to intubation (13 +/- 18 h), and had a more rapid response to medical therapy (30 +/- 18 h). Of those patients requiring intubation, most (78%) were intubated within 8 h of presentation, and the vast majority (93%) by 24 h. Of those patients responding to medical therapy, half (52%) recovered within 24 h and the vast majority (92%) recovered within 72 h. CONCLUSIONS: This study provides a better characterization of the response to therapy of COPD patients with hypercapnic respiratory failure. This should be useful in limiting or omitting medical therapy in high-risk patients, thereby avoiding delays in intubation as well as providing a framework for continued therapy in those more likely to improve.
G W Hoo; N Hakimian; S M Santiago
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Chest     Volume:  117     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2000 Jan 
Date Detail:
Created Date:  2000-02-07     Completed Date:  2000-02-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  169-77     Citation Subset:  AIM; IM; S    
Pulmonary and Critical Care Section, West Los Angeles VAMC and UCLA School of Medicine, Los Angeles, CA 90073, USA.
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MeSH Terms
Acidosis, Respiratory / blood,  etiology
Blood Urea Nitrogen
Hypercapnia / blood,  etiology*,  mortality,  therapy
Intensive Care Units
Intubation, Intratracheal
Lung Diseases, Obstructive / blood,  complications*,  mortality,  therapy
Respiration, Artificial
Respiratory Function Tests
Respiratory Insufficiency / blood,  etiology*,  mortality,  therapy
Retrospective Studies
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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