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Long-term survival according to ventilation mode in acute respiratory failure secondary to chronic obstructive pulmonary disease: a multicenter, inception cohort study
Department of Anesthesia and Intensive Care, Västervik Hospital, Västervik, Sweden; Division of Cardiovascular Medicine, Faculty of Health Sciences, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
Department of Pulmonary Medicine, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-1926-8464
Department of Pulmonary Medicine, Örebro University Hospital, Örebro, Sweden.
Division of Occupational and Environmental Sciences, Department of Clinical and Experimental Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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2010 (English)In: Journal of critical care, ISSN 0883-9441, E-ISSN 1557-8615, Vol. 25, no 3, p. 539.e13-8Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The aim of the study was to investigate 5-year survival stratified by mechanical ventilation modality in chronic obstructive pulmonary disease (COPD) patients treated in the ICU.

MATERIALS AND METHODS: Prospective, observational study of COPD patients with acute respiratory failure admitted to 9 multidisciplinary ICUs in Sweden. Characteristics on admission, including illness severity scores and the first blood gas, and survival were analyzed stratified by ventilation modality (noninvasive [NIV] vs invasive mechanical ventilation).

RESULTS: Ninety-three patients, mean age of 70.6 (SD, 9.6) years, were included. Sixteen patients were intubated immediately, whereas 77 were started on NIV. Patients who were started on NIV had a lower median body mass index (BMI) (21.9 vs 27.0; P < .01) and were younger compared to those who were intubated immediately (median age, 70 vs 74.5 years; P < .05). There were no differences in the initial blood gas results between the groups. Long-term survival was greater in patients with NIV (P < .05, log rank). The effect of NIV on survival remained after including age, Acute Physiology and Chronic Health Evaluation II score, and BMI in a multivariate Cox regression model (NIV hazard ratio, 0.44; 95% confidence interval, 0.21-0.92). Fifteen patients with failed NIV were intubated and mechanically ventilated. Long-term survival in patients with failed NIV was not significantly different from patients who were intubated immediately.

CONCLUSION: The short-term survival benefit of NIV previously found in randomized controlled trials still applies after 5 years of observation.

Place, publisher, year, edition, pages
Elsevier, 2010. Vol. 25, no 3, p. 539.e13-8
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Cardiac and Cardiovascular Systems
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URN: urn:nbn:se:oru:diva-40428DOI: 10.1016/j.jcrc.2010.02.006ISI: 000283719800028PubMedID: 20381291Scopus ID: 2-s2.0-84755160846OAI: oai:DiVA.org:oru-40428DiVA, id: diva2:1633255
Available from: 2022-01-28 Created: 2022-01-28 Last updated: 2024-01-02Bibliographically approved

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