Invasive ventilation for COPD patients

Implications of prognostic pessimism in patients with chronic obstructive pulmonary disease (COPD) or asthma admitted to intensive care in the UK within the COPD and asthma outcome study (CAOS): multicentre observational cohort study. Wildman et el. BMJ December 2007.

I think this paper has raised the profile of whether or not to invasively ventilate patients with an exacerbation of COPD. However the paper only includes the prognosis of patients actually admitted to critical care. This means that the pessimisim in these patients was not great enough for them not to be addmitted at all. Whilst a randomised trial including all patients with an exacerbation would be unethical this is a problem with the study.

Dr. Hina Pattani


2 comments so far

  1. milind21 on

    A very topical issue. As Hina says CAOS study certainly raised the profile of COPD in ICU circle.

    I used to be nihilistic about ventilating COPD patients till i looked up the evidence.

    I would like to know what people think about mortality (ICU and hospital), duration of mechanical ventilation and length of stay.

    There’s are 2 ppt presentations of the some of the evidence I have summarised available from the blue box – They are called “NIV in pneumonia presentation – Sovani” and “Mechanical Ventilation & COPD – Sovani”.

    New guidelines for ventilating COPD patients are going to be published soon.

  2. milind sovani on

    checked out good website. for all those who are waiting to rubbish another study here is one for you

    They compared standard care with (std care + cpap) for pts with severe respiratory distress in COMMUNITY.

    71 pts in total, CPAP reduced intubation rate and mortality. Alright then- over to you now- go for it

    Does anybody have access to Ann Emerg Med?

    Thompson J. Out-of-hospital continuous positive airway pressure ventilation versus usual care in acute respiratory failure: a randomized controlled trial. Ann Emerg Med. 2008 Sep;52(3):232-41, 241.e1. Epub 2008 Apr 3

    Link to pubmed abstract here


    PS I’ve changed this to comment from an original post by Milind, as at present we can’t get to the original article, which makes critical appraisal of it tricky! Hope that’s OK. Thanks for highlighting it – cheers Ed (Dan)

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