Other high-risk groups of COPD Lung Disease patients include those who survive acute exacerbations of COPD (AECOPD) and survivors of invasive mechanical ventilation (IMV). In-hospital mortality from AECOPD can be as high as 11%, and 1-year mortality is in the range of 50%.With the advent of noninvasive mechanical ventilation (NIMV) for primary treatment of AECOPD and for bridging from IMV, the in-hospital mortality rates for COPD patients can be surprisingly low. One retrospective study looked at a highly selected cohort of tracheostomized COPD Lung Diseasepatients who were referred to a regional weaning unit after having been acutely ventilated for respiratory failure.
The study reported a 95.5% successful weaning rate and a 92.5% survival to discharge. Long-term survival for those weaned from IMV approximated the poor survival expected of the worst BODE index cohort. One conclusion from these data is that patients with COPD Lung Disease who require mechanical ventilation may have a prognosis similar to patients who do not require mechanical ventilation. That is, the long-term prognosis in COPD is determined by the severity of the underlying disease rather than the need for ventilation.Thus, patients need not “get stuck” on the ventilator, as our weaning techniques continue to improve. However, the long-term prognosis for these patients is poor, and end-of-life discussions would be appropriate for all survivors of mechanical ventilation for COPD Lung Disease.