Abstract
Background: Chronic obstructive pulmonary disease with respiratory failure is frequent cause of admission in critical care units all over the world. Invasive Mechanical ventilation is one of the important management steps in dealing such patient. However this step of management is associated with high mortality and morbidity. In such patient early weaning will reduce the complications associated with invasive ventilation. Weaning failure is frequently seen in chronic obstructive pulmonary disease especially if disease is in advance stage. This is because of various pathophysiological mechanism seen in such patient. The following retrospective review focus on poor outcome in form of increase mortality and morbidity associated with invasive mechanical ventilation.
Design and setting: A retrospective review in critical care Unit of King Fahd Hospital Alhassa, Kingdom of Saudi Arabia
Method: Fifty patients admitted with respiratory failure due to advance COPD with no other co-morbidities. These patients required invasive mechanical ventilation with different modes. The patients who could be weaned off from mechanical ventilation within 72 hours were put to spontaneous breathing with oxygen for 2 hour trial. Weaning outcome was assessed by re-intubation rate, successful extubation, ventilation dependency, duration on mechanical ventilation, duration in critical care unit and death rate.
Results: 39 patients failed to maintain respiratory parameter of successful weaning and were re-intubated. Out of these 39(78%), twenty five (64%) survived to be able to shift to high dependency unit, of whom 21(54%) were able to be discharged to home after prolong ventilation(>72 hours). Total mortality rate was 14(28%), the mortality rate was high(24%) in patient with prolong ventilation(> 72 hours). Out of total 33(66%) discharged to home, 18(54%) were re-admitted to critical care unit.
Conclusions: Invasive mechanical ventilation is associated with high mortality and morbidity in advance chronic obstructive pulmonary disease (FEV1<30L/mint.) and is of not useful.