Principles of Critical Care > Part IV. Pulmonary Disorders > Chapter 39. Acute-on-Chronic Respiratory Failure Ivor S. Douglas, Gregory A. Schmidt, Jesse B. Hall

Key Points

"In the past three decades, mortality from chronic obstructive pulmonary disease (COPD) has risen dramatically, making COPD the fourth leading cause of death in 2000.¹ Compared with people with normal lung function, subjects with severe COPD (forced expiratory volume in 1 second [FEV₁] <50% predicted) followed for 22 years as part of the National Health and Nutrition Examination Survey (NHANES I) had a 2.7-fold increased risk of death (95% CI 2.1 to 3.5) in an adjusted analysis.² This trend is apparent in men and women, more prominent in black Americans, and clearly related to cigarette smoking. For the first time, in 2000 more women than men died of COPD in the U.S.¹ Admissions to ICUs for exacerbations of COPD account for a substantial portion of bed-days,³ since these patients often require prolonged ventilatory support. In surgical ICUs, COPD is an important problem as well, since it is one of the more common reasons for a prolonged postoperative recovery. An approach to this disease is an essential component of the intensivist's armamentarium...."