Source: Annual Congress 2002 - Treatment and outcome of acute respiratory failure in chronic disease
Disease area: Respiratory critical care, Respiratory infections

Abstract

Patients with mechanical ventilation (MV), have a higher mortality rate related to the severity of illnesses and the limits in diagnosis.
Aim of the study. To analyse the death causes and the concordance between the clinical and post-mortem diagnosis in patients on MV who died in the Respiratory ICU, 2 consecutive years.
Method. From 187 patients with respiratory pathology who have been on MV>48 h, we registered 61 deaths (32.6%). Complete post-mortem examination has been made in 56 patients. Clinical diagnosis of illness and death, suspected or confirmed complications, type and time of ventilatory support has been noted.
Results. The most frequent indication of MV was acute respiratory failure (ARF) in COPD exacerbations (94 patients with 18 deaths), followed by postoperative (thoracic surgery) (22 patients, 12 deaths), ARDS (12 cases, 6 deaths), hemoptysis (12 patients, 8 deaths), pulmonary tromboembolism (17 cases, 6 deaths), tuberculosis (8 cases, 2 deaths), other 22 patients with 9 deaths. In 8 cases (15,6%) from 51 post-mortem examinations, a single pathology feature was found, in the other 43 cases being found 2 or more anatomo-pathologic lesions.
Clinical diagnosis was confirmed in 64 instances from a total of 151 anatomo-pathologic findings (sensitivity 42.3%). 12 clinical diagnosis weren't confirmed.
Conclusions. Clinical diagnosis underestimates the complications in patients on MV, and this fact may contribute to the poor prognosis of these patients. The accuracy of clinical diagnosis varies upon the pathology causing the death and the resources available in a specific ICU.

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Citations should be made in the following way:
R. T. Stoica, G. Cadar, A. Macri, P. Galbenu (Bucharest, Romania). Analysis of death causes in patients with ventilatory support in a respiratory ICU. Eur Respir J 2002; 20: Suppl. 38, 611

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