Résumé :
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Introduction : Long termsurvival after intensive care of chronicle respiratory diseases exacerbations cannot be easily predicted in spite of many works carried out on the survival factors as the BODE index for the COPD. The aim of this retrospective study is to describe our patients' life expectancy after exacerbation, in order to guide the intensive care indications. Patients andmethods : We carried out a retrospective study between January 2004 and June 2008, with all the patients admitted in intensive care unit because of chronicle respiratory disease. For each patient, we collected the following pieces of information : age, gender, SAPS II of their first exacerbation, the major cause of their respiratory disease : obstructive or restrictive CRD, obesity-hypoventilation; oxygen-therapy at home before or not; need to treat the patient after the intervention by O2 or not; NIV and O2+NIV. We carried out a study of the rate of survival after reanimation 1, 2, 3, 4 or 5 years after the admission in the unit, thanks to an actuarial survival curve. Results : • 250 patients were admitted (W/M : 152/98, average age : 70, 9 years old, average SAPS II : 37, 9 during their first exacerbation). • 81 patients (32, 4%) had experienced a home oxygen-therapy before exacerbation. • Considering all the patients, the type of chronicle respiratory disease found was : COPD in 161 cases (64%), obesity and hypoventilation in 53 cases (21%), restrictive CRD in 36 cases (14%). • Only 137 patients out of 161 suffering from COPD (85%) could be classified thanks to the GOLD classification : - 27 (20%) belonged to class II, - 67 (49%) belonged to class III, - 43 (31%) belonged to class IV. • The average duration of ventilation (for 244 patients) was 7,6 (+or- 10) days : if the NIV was used (235 patients-94%) the average duration falls to 5,6 (+OR-4,2) days, and when invasive ventilation was used (78 patients-31%), it falls to 6,8 (+or- 14,8) days. • The average duration of the stay in intensive care unit was 8, 1(+or-11) days. Discussion : • A significant difference of survival was observed neither between the COPD with and without previous O2, nor between the GOLD Class II-III and IV. • After exacerbation of COPD, the setup of a NIV system alone increased the rate of survival : 87% of survival after 4 years. The setup of a NIV system combined with O2 is a factor of bad prognostic : 22% of survival after 4 years. • The prognostic of the exacerbated COPD is influenced in our unit neither by the seriousness of the GOLD Class, nor by a previous home oxygen-therapy. The two factors which seem to have a significant negative influence over life expectancy (considering the index BODE) are then the loss of weight and the physical deconditioning. • NIV enables to avoid resorting to sedations, and reduces the risk of nosocomial pneumopathies. It also enables a better physical rehabilitation. Bibliography : • Implications of prognostic pessimismin patients with chronic obstructive pulmonary disease (COPD) or asthma admitted to intensive care in the UK within the COPD and asthma outcome study (CAOS) BMJ 2007; 335;1132. • The Body-Mass Index, AirflowObstruction, Dyspnea, and Exercise Capacity Index in Chronic Obstructive Pulmonary Disease (BODE Index) :N Engl J Med 2004;350 :1005-12.
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