Anestéziológia a intenzívna medicína 2/2014

Intensive therapy unit staff´s views of chronic obstructive pulmonary disease

Introduction:Chronic Obstructive Pulmonary Disease (COPD) presents a serious medical problem. Development of acute respiratory insufficiency among these patients is the main cause of hospitalization on the intensive care departments due to need of ventilation support. Goal of our work was to find out presence and course of the hospitalization of the patients on Clinic of Anaesthesiology and Intensive Care (KAIM) in the Faculty Hospital in Trnava during the period from 2009 to 2013. Methods:It was a retrospective study of 70 patients admitted to KAIM with diagnosis of respiratory insufficiency based on the decompensation of COPD. Data were draw from the files and from the hospital information system Medea. Results were prepared in the computer program Excel. For statistical elaboration we used Mann-Whytneyov U test. We suprosed results with P<0.05as statictically significant. Results:In the followed up 5 years cycle 70 patients were hospitalized on KAIM with COPD. Most of them were GOLD III – 25 patients (35.6%) and GOLD IV – 28 patients (40%). Most of them were men (74% versus 26%). Average age was 66.7 (+/-12.2) years. Average length of hospitalization was 14.3 (±11.5) days. Most of the patients were moved from other departments, especially from the Clinic of Pulmonary Disease (43%) and from Clinic of Internal Medicine (43%). Incidence of COPD during this 5 years period was 5.5 cases on 100 hospitalization. Incidence of COPD on KAIM has decreasing tendency. All-over lethality was 33% (23 patients). The main causes of hospitalization on KAIM was acute exacerbation of COPD caused by respiratory complications as bronchopneumonia in 56%, infections of upper and lower respiratory tract (17%) and decompensation of acute cor pulmonale (14%). During monitoring average values of pH, pCO2, pO2 and SpO2 by inclusion of ventilator treatment, there were no statistically significant differences between patients who survived and those, who died. Average amount of leukocytes (16.08) and CRP (85.36 mg/l) affirm the assumption had infectious complications. Among patients, who died the amount of PCT was significantly higher than among the survived patients. Average length of ventilation (10.5 days) was longer among survivors. The most frequent ventilator regime was P-SIMV and most of the patients had ventilator support by Galileo. Conclusion:These achievements showed up relatively favourable short term prognosis, but long term prognosis of the patients with need of mechanical ventilation remain severe. Assumption of successful clinical coming out is a patient with potential reserves of cardiopulmonary system and respecting of guidelines.

Keywords: COPD, respiratory insufficiency, mechanical ventilation, intensive medicine.