Yoğun Bakımda Kronik Obstruktif Akciğer Hastalarının İzlemi

Abstract

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. vii Preventive measures aimed at these factors may help to decrease the mortality in these patients.