2007 OPEN FORUM Abstracts
IMPACT OF COPD IN A SURGICAL/TRAUMA ICU ON VENTILATOR LENGTH OF STAY
T. Gillin1, J. S. Emberger1, G. Fulda2
Background: Patients admitted to a Surgical/Trauma ICU are generally intubated and ventilated due to traumatic injuries or surgical procedures and not exacerbation of COPD. However, COPD may be a significant co-morbid factor for these patients. Dynamic air-trapping caused by COPD is well known for increasing work of breathing, but there is a lack of data in the literature showing a difference in outcomes between COPD and Non-COPD patients on mechanical ventilation in this cohort. The purpose of this study was to determine the impact of preexisting COPD on outcome of patients who require mechanical ventilation following trauma or major surgery in a Surgical/Trauma ICU patient population.
Method: We retrospectively reviewed all patients requiring mechanical ventilation in our 22 bed Surgical/Trauma ICU over a 16 month period (January 2006 - April 2007). COPD patients were identified by respiratory staff as those patients treated at home for COPD (receiving active pre-admission treatment for COPD). Data collected included: ventilator days, mortality and tracheostomy rate.
Results: Eight hundred five (805) Non-COPD ventilator patients were identified with 4983 ventilator days for 6.2 average ventilator days per patient. One hundred twenty four (124) COPD ventilator patients were identified with 2666 ventilator days for 21.5 average ventilator days per patient. Average ventilator days per patient were significantly different (p < 0.001) between the two groups. The mortality rate (20.8%, 16.1%) and percent requiring tracheostomy (14.1%, 15.3%) were not statistically different between Non-COPD and COPD patients. Figure 1 displays the percentage of patients remaining on the ventilator by time in days.
Conclusions: Patients in the Surgical/Trauma ICU with the co-morbidity of COPD remain on the ventilator about 3.5 times longer than those who do not have COPD. Despite the increased time on the ventilator, mortality and need for tracheostomy were similar between the groups. Knowing this, we should examine the COPD population for opportunities to optimize work of breathing, reduce airtrapping and perform timely and appropriate liberation trials to normalize this increased time on the ventilator.