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 critical care, may sometimes be required. Decisions to admit to critical care 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. We studied outcomes in COPD patients admitted to critical care for decompensated type II respiratory failure.

Methods: A prospective cohort study was carried out in 92 intensive care and 3 respiratory high dependency units in the United Kingdom. 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 180-day survivors.

Conclusions: Most patients with COPD who survive to 180 days after ICU 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