Yoğun Bakımda Kronik Obstruktif Akciğer Hastalarının İzlemi
Özet
Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic
morbidity and mortality in the world. According to World Health Organisation data,
there are 600 million of COPD patients in the world and 2,3 million people die
because of this disease per year. Most of COPD patients are needed hospitalisation at
intensive care unit (ICU), due to respiratory failure. In this report, it is aimed to
investigate the independent risk factors that may affect mortality of COPD cases
treted and followed up at Hacettepe University Medicine Faculty Anesthesiology
İntensive Care Unit via retrospective review of demographic properties,
comorbidities, hospitalisation time in ICU. 36% of the fifty COPD patients were
female, 64% were male. The mean age was 72,4±11,6 years. 88% of patients were
admitted from Adult Emergency Clinic. Mean APACHE II score was found14,7±8,6
at admission. The mean Glasgow Coma Score (GCS) was 13,1±4. The mean
duration of hospital stay was 20,14±25,3 days. The mortality rate was 18% and
12% of patients died during their hospital stay period. The mean ventilation time was
11,66±16,9 days. During follow up, acute kidney failure in 24% of patients, ARDS
in 6%, gastrointestinal bleeding in 6%, pneumothorax in 2%, sepsis in 18%,
ventilator associated pneumonia in 10% of patients was recorded. Patients were
divided into two groups whether the patient survived until ICU or not. In patents who
died in ICU, the mean duration of ICU stay (p=0,017), hospital stay before ICU
admission (p=0,025) and duration of mechanic ventilation (p=0,01) were found to be
longer compared to the survivors. Also the worst lactate levels (p=0,024), discharge
and the worst pH levels (p=0,000), worst pCO2 levels (p=0,025) were found to be
worse in patients who died in ICU than the survivors. Sepsis (p=0,000), acute kidney
failure (p=0,027) and myocardial infarction (p=0,029), tracheostomy need (p=0,019),
ventilator associated pneumonia (p=0,002) were statistically significantly. According
to logistic regression analysis admission from Emergency Clinic, developing
myocardial infarction in ICU were independent risk factors of death.
We conclude that admission from the Emergency department and myocardial
infarction were independent predictors of death in COPD patients admitted ICU.
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Preventive measures aimed at these factors may help to decrease the mortality in
these patients.