Non invasive predictors for decision making in acute exacerbation of chronic obstructive pulmonary disease [AECOPD]

ABSTRACT

Accurate prediction for prognosis is important for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease [AECOPD] requiring mechanical ventilation [MV] and for proper assessment of decision making regarding plane of management and ongoing hospital morbidity and mortality. The present study was designed to determine the predictability of non invasive parameters including APACHE II score, arterial blood gases [ABGs] and bedside Echocardiography in management of critically ill patients with COPD exacerbation either invasively or conservatively. The study was conducted on 60 adult patients [50 male and 10 female] with AECOPD, with mean age 60.1 +/- 6.2 were admitted to intensive care unite [ICU]. All patients were subjected to arterial blood gases [ABGs], APACHE II score and bedside Echocardiography study. Patients were divided into two groups according to ventilatory requirement invasive or non invasive into group I [34 patients] with need of MV and group II [26 patients] with success of conservative treatment. We found that APACHE II score, had a high predictive value for MV necessity, it was 19.17 +/- 3.4 in the group I Vs 11.46 +/- 4.4 in the group II also Doppler evidence of pulmonary hypertension had high predictive value for MV necessity. The mean value of PASP was 48.95 +/- 12.44mmHg in group I, Vs 30.71 +/- 6.5mmHg in group II with significant p value. The mean value of PAPm was 42.08 +/- 6.89mmHg in group I Vs 31.50 +/- 7.71 mmHg in group II with significant p value. Increases in the APACHE II score, the mean pulmonary artery pressure [PAPm] and pulmonary artery systolic pressure [PASP] were significantly more in patients who died in comparison to survivors in the group I. APACHE II score, bedside Echocardiography and routine arterial blood gases could be used as a marker to identify patients at the time of admission who are likely to have a poor prognosis, so that such patients can be managed aggressively, either medical conservative treatment or mechanical ventilation [NIPPV or Invasive MV]