Dept of Respiratory and Critical Care Medicine, Otto Wagner Spital, Vienna.
Eur Respir J. 2013 Apr;41(4):792-9. doi: 10.1183/09031936.00226411. Epub 2012 Sep 27.
The epidemiology of chronic obstructive pulmonary disease (COPD) in critically ill patients is largely unknown. The aims of the study were: 1) to determine whether COPD, either as the cause of intensive care unit (ICU) admission or as a comorbid condition, is an independent risk factor for increased morbidity and mortality; and 2) to investigate time trends in proportion and outcome of acute respiratory failure in patients with COPD admitted to ICUs. Prospectively recorded data from 194 453 adults consecutively admitted to 87 Austrian ICUs over a period of 11 years (1998-2008) were retrospectively analysed. COPD was present in 8.6% of all patients. The risk-adjusted mortality of patients with COPD was higher than in patients without COPD. The presence of COPD was an independent risk factor for increased mortality and was associated with prolonged mechanical ventilation and prolonged weaning. During the course of the 11 years, the proportion of acute respiratory failure due to COPD increased by about two-thirds, and the use of noninvasive ventilation within the COPD cohort more than doubled. Simultaneously, the risk-adjusted mortality of patients with COPD improved. In critically ill patients, the presence of COPD is increasing and is an independent risk factor for mortality and morbidity.
慢性阻塞性肺疾病（COPD）在危重症患者中的流行病学情况在很大程度上尚不清楚。本研究的目的是：1）确定 COPD 是否作为入住重症监护病房（ICU）的原因或作为合并症，是增加发病率和死亡率的独立危险因素；以及 2）调查 ICU 收治的 COPD 患者急性呼吸衰竭的比例和结局的时间趋势。对 1998 年至 2008 年期间连续收治的 87 家奥地利 ICU 的 194453 例成年人的前瞻性记录数据进行了回顾性分析。所有患者中 COPD 的发生率为 8.6%。患有 COPD 的患者的风险调整死亡率高于没有 COPD 的患者。COPD 的存在是增加死亡率的独立危险因素，并且与机械通气时间延长和撤机时间延长相关。在 11 年的时间里，由于 COPD 导致的急性呼吸衰竭的比例增加了约三分之二，COPD 队列中无创通气的使用增加了一倍多。同时，患有 COPD 的患者的风险调整死亡率得到了改善。在危重症患者中，COPD 的存在正在增加，并且是死亡率和发病率的独立危险因素。
