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Purpose

TWO-YEAR SURVIVAL OF CASES WITH SEVERE COPD REQUIRING INVASIVE MECHANICAL VENTILATION AND FACTORS AFFECTING SURVIVAL Bülent Özbay, Selvi Aşker, Hanifi Yıldız, Bünyamin Sertoğullarından, Selami Ekin Yüzüncü Yıl University, School of Medicine, Department of Chest Diseases, Van, Turkiye. Purpose.

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Purpose

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  1. TWO-YEAR SURVIVAL OF CASES WITH SEVERE COPD REQUIRING INVASIVE MECHANICAL VENTILATION AND FACTORS AFFECTING SURVIVALBülent Özbay, Selvi Aşker, Hanifi Yıldız, Bünyamin Sertoğullarından, Selami EkinYüzüncü Yıl University, School of Medicine, Department of Chest Diseases, Van, Turkiye.

  2. Purpose To investigate two-year survival and factors affecting survival of cases with severe COPD requiring invasive mechanical ventilation

  3. Methods • 69 cases with COPD requiring invasive mechanical ventilation in intensive care unit between 2005 and 2007, were recruited the study.(21 female , 48 male)

  4. Methods • The association between age, gender, duration of illness, blood gas values, ejection fraction, laboratory test results (AST; ALT, LDH and hematocrit values) and survival were investigated.

  5. Methods • Exclusion criteria • Pneumonia • Asthma • Restrictive lung disease • Obesity • Kyphoscoliosis

  6. MethodsPulmonary artery pressure and ejection fraction were determined by echocardiograph

  7. Methods • Cases that were alive in 3rd, 6th, 12th and 24th months were determined by phone interview.

  8. Statistic analysis • One way Anova • Chi-square (2) test

  9. Results • 21 female and 48 male patients were recruited. (Mean male age was 63 11, mean female age was 709)

  10. RESULTS • In-hospital mortality was %47. • Mortality was %61, %78, %84, and %85.5 at the end of 3rd, 6th, 12th, and 24th months, respectively.

  11. RESULTS • No difference was determined between genders in any period (p>0.05).

  12. RESULTS • Only age had an influence on the mortality at end of 3rd month (p<0.05). • Mean age of • Death70 • Alive60

  13. RESULTS

  14. Results • At 6th month, duration of illness were affecting the survival (p<0.05). • Duration of illness • Death7.5 years • Living14 years

  15. RESULTS • Hematocrit level affected the mortality at the end of 12th and 24th months (p<0.05). • Survival was higher in patients with a high hematocrit level

  16. Requiring mechanical ventilation Increased in-hospital mortality After hospitalisation mortality? 1-Severe acute exacerbations and mortality in patients.with chronic obstructive pulmonary disease. J.J. Soler-Cataluna, M.A. Martinez-Garcia, P. Roman Sanchez, E. Salcedo, M. Navarro, R. Ochando Thorax 2005;60:925–31

  17. COPDInvazive mechanical ventilation Prognosis=worse? 1-Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995 Sep 28;333(13):817-22 ACP J Club. 1996 Mar-Apr;124(2):29. N Engl J Med. 1995 Sep 28;333(13):870-1. N Engl J Med. 1996 Mar 14;334(11):735-6. 2-Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Plant PK, Owen JL, Elliott MW. Lancet. 2000 Jun 3;355(9219):1931-5

  18. In-hospital mortalityhigh 1-Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease.Seneff MG, Wagner DP, Wagner RP, Zimmerman JE, Knaus WA. JAMA. 1995 Dec 20;274(23):1852-7 . 2-Mortality in intensive care patients with respiratory disease. Is age important?Heuser MD, Case LD, Ettinger WH. Arch Intern Med. 1992 Aug;152(8):1683-8.

  19. COPD requering invasive mechanical ventilation • Mortality rates • Factors effecting mortality 1- Acute hypercapnic respiratory failure Irfan Ucgun, Muzaffer Metintas, Hale Moral, Fusun Alatas, Huseyin Yildirim, Sinan Erginel Department of Chest Diseases, Medical Faculty, Osmangazi University, Respiratratory medicine (2006)100 66-74

  20. %52.9 mortality 1-Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU fo acute hypercapnic respiratory failure Irfan Ucgun, Muzaffer Metintas, Hale Moral, Fusun Alatas, Huseyin Yildirim, Sinan Erginel Department of Chest Diseases, Medical Faculty, Osmangazi University, Respiratratory medicine (2006)100 66-74

  21. Low Glascow coma score high mortality • High CO2  high mortality • Compansated metebolism Increased survival 1-Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU fo acute hypercapnic respiratory failure Irfan Ucgun, Muzaffer Metintas, Hale Moral, Fusun Alatas, Huseyin Yildirim, Sinan Erginel Department of Chest Diseases, Medical Faculty, Osmangazi University, Respiratratory medicine (2006)100 66-74

  22. Low Hb value mortality unaffected 1-Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU fo acute hypercapnic respiratory failure Irfan Ucgun, Muzaffer Metintas, Hale Moral, Fusun Alatas, Huseyin Yildirim, Sinan Erginel Department of Chest Diseases, Medical Faculty, Osmangazi University, Respiratratory medicine (2006)100 66-74

  23. Severe atackIncreased mortality Older age and higher CO2 cons.Increased mortality 1-Severe acute exacerbations and mortality in patients.with chronic obstructive pulmonary disease. J.J. Soler-Cataluna, M.A. Martinez-Garcia, P. Roman Sanchez, E. Salcedo, M. Navarro, R. Ochando Thorax 2005;60:925–31

  24. In-hospital mortality%25.2 1-In-hospital and 2-year survival of patients treated with mechanical ventilation for acute exacerbation of COPD. Raurich JM, Pérez J, Ibáñez J, Roig S, Batle S. Arch Bronconeumol. 2004 Jul;40(7):295-300

  25. Older age,higher PAP, multisystemic disorders ıncreased in-hospital mortality 1-In-hospital and 2-year survival of patients treated with mechanical ventilation for acute exacerbation of COPD. Raurich JM, Pérez J, Ibáñez J, Roig S, Batle S. Arch Bronconeumol. 2004 Jul;40(7):295-300

  26. Severe pulmonary diseasesIncreased mortality 1-In-hospital and 2-year survival of patients treated with mechanical ventilation for acute exacerbation of COPD. Raurich JM, Pérez J, Ibáñez J, Roig S, Batle S. Arch Bronconeumol. 2004 Jul;40(7):295-300

  27. Nutritional status, life qualitynot considered 1-In-hospital and 2-year survival of patients treated with mechanical ventilation for acute exacerbation of COPD. Raurich JM, Pérez J, Ibáñez J, Roig S, Batle S. Arch Bronconeumol. 2004 Jul;40(7):295-300

  28. Low Htc valueIncreased mortality and morbidity Prognostic value of the hematocrit in patients with severe COPD receiving long-term oxygen therapy. chambellan A, Chailleux E, Similowski T; ANTADIR Observatory Group. Chest. 2005 Sep;128(3):1201-8

  29. Low Hb valueIncreased mortality Cause of low Hb value in some of patients with COPD? The potential impact of anaemia of chronic disease inCOPD. Similowski T, Agustí A, MacNee W, Schönhofer B. Eur Respir J. 2006 Feb;27(2):390-6.

  30. Low Hb Increased mortality 1-Prognosis of chronic obstructive pulmonary disease after acute respiratory failure Lee CM, Shieh BF, Lin FJ, Kao HT, Huang WC. Zhonghua Yi Xue Za Zhi (Taipei). 1989 Mar;43(3):191-6. 2-Long-term results of intermittent ventilatory assistance for 74 severe obstructive chronic respiratory insufficient patients (PaCO2 greater than 50 Torr) ventilated for more than a year (author's transl Muir JF, Hermant A, Laroche D, Lévi-Valensi P, Duwoos H. Rev Fr Mal Respir. 1979 Jul-Aug;7(4):421-3.

  31. ErytrositosisIncreased survival Erythropoietin level and macrocytosis in patients with chronic pulmonary, insufficiency.Pavlović-Kentera VBogdanović M, Miladinović D, Slavković V. Respiration. 1977;34(4):213-9.

  32. Results Our in-hosital mortality rates are comparable

  33. Factors increasing the mortalityIn-hospitalTwo-year follow-up period

  34. A positive correlation was found between older age and mortality that is comparable with other similar studies

  35. A positive correlation betwen duration of illness and survival • Higher Htc value  Increased survival • Compensatory mechanism may have protective effect

  36. PAP not have an affect on survival

  37. Increased AST and ALT not affect the mortality

  38. CONCLUSİON • Age, duration of illness and hematocrit level were appeared to the factors affecting the survival in patients with COPD requiring invasive mechanical ventilation. Others weren’t affecting the survival.

  39. Waterfall of Muradiye

  40. The Akdamar island of The Van

  41. The Castle of Van

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