Pronóstico de los enfermos con enfermedad pulmonar obstructiva crónica reagudizada que precisan ventilación mecánica

Objective. To determine the variables associated with prognosis for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in mechanically ventilated patients. Design. Prospective cohort study with retrospective analysis. Location. 361 Intensive Care Units (ICU) in 20 countries. Patients and methods. There were included in the study 522 patients who required mechanical ventilation for more than 12 hours due to an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In order to determine those variables associated with mortality, there was performed a recursive partition analysis in which the following variables were included: demographics, arterial blood gas prior to intubation, complications arising during mechanical ventilation (barotrauma, acute respiratory distress syndrome, ventilator-associated pneumonia, sepsis), organ dysfunction (cardiovascular, renal, liver, coagulation) and duration of ventilatory support. Interventions. None. Variables of prime importance. ICU mortality. Results. ICU and hospital mortality rates were 22% and 30%, respectively. Variables associated with mortality were cardiovascular dysfunction, renal dysfunction and duration of ventilatory support > 18 days. Median durations were as follows: mechanical ventilatory support, 4 days (P₂₅: 2, P₇₅: 6); weaning from ventilatory support, 2 days (P₂₅: 1, P₇₅: 5); stay in intensive care unit, 8 days (P₂₅: 5, P₇₅: 13); stay in hospital, 17 days (P₂₅: 10, P₇₅: 27). Conclusions. Mortality in the studied cohort of patients with AECOPD was associated with cardiovascular dysfunction, renal dysfunction and prolonged mechanical support.