Abstract Background Mechanical ventilation (MV) for acute respiratory failure in chronic obstructive pulmonary disease (COPD) carries substantial morbidity and mortality. While MV management strategies in COPD are well described, prognostication within COPD subgroups remains uncertain. We examined whether FEV1-based COPD severity is associated with clinical outcomes after intubation. Methods We conducted an 11-year retrospective cohort study at a rural Level I trauma center. Adults with COPD who required endotracheal intubation and 24 hours of MV were identified; of these, patients with pulmonary function testing within 5 years of intubation were included. Based on pre-intubation FEV1, patients were categorized as mild/moderate or severe/very severe COPD. Outcomes included in-hospital mortality (primary), discharge to home, and 30-day and 90-day readmissions. Prespecified subgroup analyses assessed baseline oxygen dependence. Comparisons were made using Chi-square or Wilcoxon rank sum tests, with p 0.05 considered statistically significant. Results Among 1,761 eligible patients, 757 had mild/moderate COPD and 1,004 had severe/very severe COPD. In-hospital mortality was higher in the mild/moderate group than in the severe/very severe group (31.6% vs 23.7%; P 0.05). A greater proportion of patients with severe/very severe COPD were discharged home (18.7% vs 14.7%; P 0.05). Among patients not oxygen-dependent at baseline, mortality was lower in the severe/very severe group (22.2% vs 32.8%; P 0.05). Among oxygen-dependent patients, outcomes did not differ significantly between groups. 30-day, 90-day, and overall readmission rates were similar across groups. Conclusions COPD severity defined by FEV1 alone did not correlate with worse outcomes after prolonged MV; paradoxically, patients with severe/very severe COPD had lower in-hospital mortality and were more likely to be discharged home than those with mild/moderate disease. These findings may reflect earlier recognition and intubation in patients with limited pulmonary reserve and/or clinician selection based on factors beyond FEV1. Further phenotype-based analyses are warranted to refine risk stratification in ventilated COPD patients. This abstract is funded by: None
Buntic et al. (Fri,) studied this question.