Chest
Volume 125, Issue 5, May 2004, Pages 1815-1820
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Clinical Investigations in Critical Care
Survival of Patients With Bronchiectasis After the First ICU Stay for Respiratory Failure

https://doi.org/10.1378/chest.125.5.1815Get rights and content

Study objectives

Respiratory failure (RF) is a frequent cause of death among patients with bilateral bronchiectasis. An ICU admission is commonly required, and neither short-term or long-term outcomes have been studied.

Design

We performed a retrospective study over a 10-year period (January 1990 to March 2000). All patients with bilateral bronchiectasis admitted for the first time in the medical ICU for RF were reviewed. Patients with cystic fibrosis were excluded.

Measurements and results

Forty-eight patients (mean age ± SD, 63 ± 11 years; mean simplified acute physiology score [SAPS] II, 32 ± 12) of whom 25% received long-term oxygen therapy (LTOT) were identified. All the patients were treated with intensive medical care, associated with noninvasive ventilation in 13 patients (27%), and 26 patients (54%) required intubation. Nine patients (19%) died in the ICU. The 1-year mortality rate was 40%. Among the variables recorded at ICU admission, age > 65 years (p = 0.002), SAPS II score > 32 (p = 0.012), use of LTOT (p = 0.047), and intubation (p = 0.027) were associated with reduced survival in univariate analysis by Cox regression. Multivariate analysis by Cox proportional hazard model showed that age > 65 years (relative risk [RR], 2.70; 95% confidence interval [CI], 1.15 to 6.29) and use of LTOT (RR, 2.52; 95% CI, 1.15 to 5.54) were independently associated with reduced survival.

Conclusions

We performed the first study providing information related to the impact of the first ICU stay for RF on long-term outcomes for patients with bilateral bronchiectasis. Age > 65 years and prior use of LTOT were associated with reduced survival.

Section snippets

Patients

All adults with bronchiectasis admitted between January 1990 and March 1999 to the medical ICU at Rennes University Hospital were identified from admission records. The outcome was survival at March 1, 2000, which was used as the end of the study period to ensure that all patients had a potential of 1 year of observation time. Medical records were reviewed to ensure that cough and sputum production were reported by patients at least 5 years before the admission to ICU. In addition to the above

Results

Sixty-seven adults with bronchiectasis were identified over the 9-year study period. Forty-eight patients were included in the analysis. Among the 19 patients who were not included in the study, 3 patients had a previous ICU stay for RF, 7 patients required ICU admission for a reason other than RF (acute renal failure, n = 2; hyponatremia and seizure, n = 2; liver transplantation, n = 1; meningitis, n = 2), 7 patients had chest radiographic and CT features of unilateral bronchiectasis, and 2

Discussion

During the last decade, the literature focusing on the prognosis of bronchiectasis has been limited.11 Furthermore, patients with bronchiectasis are generally excluded from clinical studies performed in ICU12 because the mechanisms leading to RF appear particularly complex. As a result, data on short-term and long-term outcomes after an ICU stay are lacking for this disease.

We analyzed the survival of 48 patients with bilateral bronchiectasis after their first admission in ICU for RF. Nine

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