ABSTRACT
BACKGROUND: Patients with COPD are at a high risk for pulmonary embolism (PE) because of systemic inflammation and co-existing comorbidities. We aimed to determine the incidence, risk factors, and impact of PE during COPD exacerbation requiring mechanical ventilation. METHODS: This prospective cohort study was conducted between March 2013 and May 2017. Subjects with severe COPD exacerbation requiring mechanical ventilation were included. A lower-limb ultrasonography or a multidetector helical computed tomography scan (MDCT) was performed according to Wells score. Subjects with ultrasonographic signs of phlebitis underwent MDCT to confirm PE. RESULTS: During the study period, 131 COPD subjects were admitted to the ICU for severe COPD exacerbation. The incidence of PE was 13.7%. Factors independently associated with PE were increased sputum volume (odds ratio [OR] = 0.106, 95% CI 0.029-0.385, P = .001), recent immobilization ≥ 7 d (OR = 5.024, 95% CI 1.470-17.170, P = .01), age ≥ 70 y (OR = 5.483, 95% CI 1.269-23.688, P = .02), and invasive mechanical ventilation at ICU admission (OR = 3.615, 95% CI 1.005-13.007, P = .049). ICU mortality was higher in the PE group (44% vs 11%). Predictive factors of mortality were PE (OR = 7.135, 95% CI 2.042-24.931, P = .002), SAPS II score at admission OR = 1.040, 95% CI 1.005-1.077, P = .02), and duration of mechanical ventilation (OR = 1.098, 95% CI 1.044-1.154, P < .001). CONCLUSION: PE was found to be a common etiology of severe exacerbation of COPD, leading to high mortality. Age, invasive mechanical ventilation, and immobilization were risk factors for PE.
Subject(s)
Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/mortality , Pulmonary Embolism/mortality , Aged , Female , Humans , Incidence , Male , Middle Aged , Prospective Studies , Pulmonary Disease, Chronic Obstructive/therapy , Pulmonary Embolism/etiology , Respiration, Artificial/mortality , Risk Factors , Severity of Illness Index , Symptom Flare UpABSTRACT
BACKGROUND: The incidence and risk factors for delirium vary among studies. OBJECTIVE: We aimed to determine the incidence, risk factors, and impact on outcome of delirium in a medical Intensive Care Unit (ICU) in Tunisia using a prospective observational study. PATIENTS: All consecutive patients admitted to the ICU between May 2012 and April 2013 were included if they were aged more than 18 years and had an ICU stay of more than 24 h. Patients who had a cardiac arrest or have a history of dementia or psychosis were excluded. Patients eligible for the study were evaluated by the medical staff to detect delirium using the CAM-ICU. RESULTS: A total of 206 patients were included, 167 did not present delirium and 39 (19%) were analyzed for delirium. Delirious patients had a significantly longer duration of mechanical ventilation (10 days[6-20] vs. 2 days[0-7]) respectively and length of stay in ICU (21.5 days [10.5-32.5] vs. 8 days [5-13]), with no impact on mortality. Delirium was associated with high incidence of unintentional removal of catheters (39% vs. 9%; P < 0.0001), endotracheal tubes (18% vs. 1%; P < 0.0001), and urinary catheters (28% vs. 2%, P < 0.0001). In multivariable risk regression analysis, age (odds ratio [OR] = 4.1, 95% confidence interval [CI]: 1.39-12.21; P = 0.01), hypertension (OR = 3.3, 95% CI: 1.31-8.13; P = 0.011), COPD (OR = 3.5, 95% CI: 1.47-8.59; P = 0.005), steroids (OR = 2.8, 95% CI: 1.05-7.28; P = 0.038), and sedation (OR = 5.4, 95% CI: 2.08-13.9; P < 0.0001) were independent risk factors for delirium. We did not find a relationship between delirium and mortality. CONCLUSION: Delirium is frequent in the ICU and is associated with poor outcome. Several risk factors for delirium are linked to intensive care environment.
