Survival and quality of life for patients with COPD or asthma admitted to intensive care in a UK multicentre cohort: the COPD and Asthma Outcome Study (CAOS)
- 1Sheffield Thoracic Institute, Northern General Hospital, Sheffield, UK
- 2Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK
- 3Heartlands Hospital, Birmingham, UK
- 4Department of Environmental and Occupational Medicine, University of Aberdeen, UK
- 5Intensive Care National Audit and Research Centre, London UK
- 6Nuffield Department of Anaesthetics, Oxford, UK
- Dr M J Wildman, Sheffield Thoracic Institute, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK; martin.wildman{at}sth.nhs.uk
- Received 30 September 2007
- Accepted 23 September 2008
- Published Online First 13 October 2008
Abstract
Background: Non-invasive ventilation is first-line treatment for patients with acutely decompensated chronic obstructive pulmonary disease (COPD), but endotracheal intubation, involving admission to an intensive care unit, may sometimes be required. Decisions to admit to an intensive care unit are commonly based on predicted survival and quality of life, but the information base for these decisions is limited and there is some evidence that clinicians tend to be pessimistic. This study examined the outcomes in patients with COPD admitted to the intensive care unit for decompensated type II respiratory failure.
Methods: A prospective cohort study was carried out in 92 intensive care units and 3 respiratory high dependency units in the UK. Patients aged 45 years and older with breathlessness, respiratory failure or change in mental status due to an exacerbation of COPD, asthma or a combination of the two were recruited. Outcomes included survival and quality of life at 180 days.
Results: Of the 832 patients recruited, 517 (62%) survived to 180 days. Of the survivors, 421 (81%) responded to a questionnaire. Of the respondents, 73% considered their quality of life to be the same as or better than it had been in the stable period before they were admitted, and 96% would choose similar treatment again. Function during the stable pre-admission period was a reasonable indicator of function reported by those who survived 180 days.
Conclusions: Most patients with COPD who survive to 180 days after treatment in an intensive care unit have a heavy burden of symptoms, but almost all of them—including those who have been intubated—would want similar intensive care again under similar circumstances.
Footnotes
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‣ Tables 4 and 5 are published online only at http://thorax.bmj.com/content/vol64/issue2
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Contributors: MJW, CS, KR, JA, BR and DY were involved in the original design of the study. MJW coordinated the study and carried out the initial data analysis and drafting of the paper. JG helped to collect the data. CS carried out additional analyses and drafted the final paper. KR and DH helped recruit the units and facilitated data linkage with the CMP. All the authors revised the manuscript critically for important intellectual content and approved the final version. MW is the guarantor.
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Funding: MW was funded by an MRC Health Services Research Fellowship. JG was funded by an NHS R & D grant. The funder had no role in the design, analysis, interpretation or reporting of this research.
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Competing interests: None.
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Ethics approval: The study had multicentre research ethics committee approval.
