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(Chest. 2005;128:1209-1215.)
© 2005 American College of Chest Physicians

Effects of Acute on Chronic Respiratory Failure on Hypercapnia and 3-Month Survival*

Michele Vitacca, MD; Luca Bianchi, MD; Luca Barbano, MD; Mara Ziliani, MD and Nicolino Ambrosino, MD, FCCP

* From the Respiratory Department (Drs. Vitacca, Bianchi, Barbano, and Ziliani), Salvatore Maugeri Foundation, Istituto di Ricovero e Cura a Carattere Scientifico, Scientific Institute of Gussago, Gussago, Italy; and Pulmonary Unit (Dr. Ambrosino), Cardio-Thoracic Department, University Hospital of Pisa, Pisa, Italy.

Correspondence to: Michele Vitacca, MD, Foundation S. Margery, Istituto di Ricovero e Cura a Carattere Scientifico, Via Pinidolo 23, 25064 Gussago (BS), Italy; e-mail: mvitacca{at}fsm.it

Background: There is a lack of information on respiratory function and mechanics after COPD exacerbations.

Study objectives: To find their role in short-term survival and occurrence of chronic hypercapnia after these events.

Patients and interventions: Seventy-three COPD patients recovering from a recent severe exacerbation underwent evaluation of breathing pattern, breathing mechanics, lung function, and arterial blood gas levels at the time of discharge from a respiratory ICU (RICU).

Results: The 3-month mortality rate after RICU discharge was 11%. The percent of ideal body weight (%IBW) [R = 6.04; p = 0.01] and occlusion pressure (R = 5.41; p = 0.02) provided significant distinction between deceased patients and survivors; the final discriminant equation showed that %IBW was able to predict patient death or survival with an accuracy of 90%. With decreasing order of power, the ratio of inspiratory time to total breathing cycle time (TI/TTOT) [R = 8.87; p = 0.003], pressure-time product of the inspiratory muscles (R = 7.12; p = 0.009), maximal esophageal pressure (R = 6.00; p = 0.01), esophageal pressure (R = 5.50; p = 0.02), PaO2/fraction of inspired oxygen (R = 4.72; p = 0.03), and pressure time index (PTI) [R = 4.57; p = 0.03] provided a significant distinction between hypercapnia and normocapnia at discharge. The discriminant equation, including TI/TTOT and PTI, could correctly separate hypercapnic or normocapnic patients with an accuracy of 76%.

Conclusions: In COPD patients who are recovering from a severe exacerbation, hypercapnia is strongly related to inspiratory muscle work, strength, and breathing pattern; and only body weight predicts short-term survival.

Key Words: acute exacerbations of COPD • lung function • respiratory failure • respiratory muscles






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