Nevins and Epstein identified prognostic factors for a patient with chronic obstructive pulmonary disease (COPD) who requires mechanical ventilation. These can help identify a patient who has a high risk of a poor outcome. The authors are from Tufts University in Boston.


Prognostic factors indicating a worse prognosis that are available shortly after starting mechanical ventilation:

(1) presence of active malignancy

(2) presence of an APACHE II comorbidity (congestive heart failure, chronic renal failure, immunosuppression, cirrhosis)

(3) high acute physiology score (APS) from the APACHE II at 6 hours. The APS for survivors was 7 +/- 5. The APS for nonsurvivors was 11 +/- 6.


Additional poor prognostic factors:

(4) mechanical ventilation required for > 72 hours

(5) extubation failure


The in-hospital mortality rate for a low risk patient (acute exacerbation without active malignancy or comorbid condition) was around 12%. The length of hospitalization and the mortality rate increase as the number of poor prognostic factors increase.


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