Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 10 , ISSUE 2 ( April, 2006 ) > List of Articles


A comparative study of characteristics and outcome of patients with acute respiratory failure and acute on chronic respiratory failure requiring mechanical ventilation

Amit Banga, G. C. Khilnani

Keywords : APACHE II score, ICU, mortality, non-pulmonary organ dysfunction, prognostic markers

Citation Information : Banga A, Khilnani GC. A comparative study of characteristics and outcome of patients with acute respiratory failure and acute on chronic respiratory failure requiring mechanical ventilation. Indian J Crit Care Med 2006; 10 (2):80-87.

DOI: 10.4103/0972-5229.25920

License: CC BY-ND 3.0

Published Online: 01-07-2010

Copyright Statement:  Copyright © 2006; The Author(s).


Background and Aims: Patients with respiratory failure requiring assisted ventilation form a large diagnostic group among critically ill patients. The outcome of patients with acute respiratory failure (ARF) as compared to those with acute on chronic respiratory failure (ACRF), may be different. The present study was designed to evaluate the clinical and acid base profile at presentation, hospital course and outcome in patients with ARF and ACRF requiring ventilatory support and to define factors that influence the outcome of these two groups of patients. Materials and Methods: Fifty patients with respiratory failure {ACRF (n=27) and ARF (n=23)} who required invasive mechanical ventilation, were included in a prospective fashion. Clinical data including APACHE II score, blood gas analysis and renal and liver functions were recorded at presentation and for the next three days. Survival to hospital discharge was the primary outcome measure. Various parameters were compared between ARF and ACRF, as well as between survivors and non-survivors to define predictors of mortality. Results: Patients with ARF were significantly younger (41.5 versus 64.4 years, P < 0.001), but all other baseline parameters including APACHE II score were similar for the two groups. During the hospital course, mean blood urea and serum creatinine became significantly higher in patients with ARF (P < 0.001). Mortality was significantly higher for patients with ARF (74% versus 48%, P =0.009). For the whole study group, APACHE II score and serum creatinine, 48 hrs after admission, were independent predictors of mortality. Conclusions: Although patients with ARF and ACRF may appear equally ill at presentation, mortality is higher for patients with ARF. A higher incidence of complications such as development of non-pulmonary organ failure during the hospital course in patients with ARF, seems to be responsible for this increased mortality.

PDF Share
  1. Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: A 28-day international study. JAMA 2002;287:345-55.
  2. Ludwigs UG, Baehrendtz S, Wanecek M, Matell G. Mechanical ventilation in medical and neurological diseases:11 years of experience. J Intern Med 1991;229:117-24.
  3. Spicher JE, White DP. Outcome and function following prolonged mechanical ventilation. Arch Intern Med 1987;147:421-5.
  4. Weiss SM, Hudson LD. Outcome from respiratory failure. Crit Care Clin 1994;10:197-215.
  5. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
  6. Harrington JT, Cohen JJ, Kassirer JP. Mixed acid-base disturbances. In: Cohen JJ, Kassirer JP, eds. Acid-Base. Little, Brown & Co: Boston; 1982. p. 377-90.
  7. Muir JF, Levi-Valensi P. When should patients with COPD be ventilated. Eur J Respir Dis 1987;70:135-9.
  8. Editorial. To ventilate or not. Lancet 1991;337:463-4.
  9. Sluiter HJ, Blokzjil EJ, van Dijl W, van Haeringen JR, Hilvering C, Steenhuis EJ. Conservative and respirator treatment of acute respiratory insufficiency in patients with chronic obstructive lung disease: A reappraisal. Am Rev Resp Dis 1972;105:932-43.
  10. Ely EW, Baker AM, Evans GW, Haponik EF. The distribution of costs of care in mechanically ventilated patients with chronic obstructive pulmonary disease. Crit Care Med 2000;28:408-13.
  11. Moran JL, Green JV, Homan SD, Leeson RJ, Leppard PI. Acute exacerbations of chronic obstructive pulmonary disease and mechanical ventilation: A reevaluation. Crit Care Med 1998;26:71-8.
  12. Kramer N, Meyer TJ, Meharg J, Cece RD, Hill NS. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 1995;151:1799-806.
  13. Vasilyev S, Schaap RN, Mortensen JD. Hospital survival rates of patients with acute respiratory failure in modern respiratory intensive care units. An international, multicenter, prospective survey. Chest 1995;107:1083-8.
  14. Zilberberg MD, Epstein SK. Acute lung injury in the medical ICU: Comorbid conditions, age, etiology and hospital outcome. Am J Respir Crit Care Med 1998;157:1159-64.
  15. Kollef MH, O′Brien JD, Silver P. The impact of gender on outcome from mechanical ventilation. Chest 1997;111:434-41.
  16. Steiner T, Mendoza G, De Georgia M, Schellinger P, Holle R, Hacke W. Prognosis of stroke patients requiring mechanical ventilation in a neurological critical care unit. Stroke 1997;28:711-5.
  17. Luhr OR, Antonsen K, Karlsson M, Aardal S, Thorsteinsson A, Frostell CG. Jan Bonde and the ARF study group. Incidence and Mortality after Acute Respiratory Failure and Acute Respiratory Distress Syndrome in Sweden, Denmark and Iceland. Am J Respir Crit Care Med 1999;159:1849-61.
  18. Behrendt CE. Acute respiratory failure in the United States. Chest 2000;118:1100-5.
  19. Sweet SJ, Glenney CU, Fitzgibbons JP, Friedmann P, Teres D. Synergistic effect of acute renal failure and respiratory failure in the surgical intensive care unit. Am J Surg 1981;141:492-6.
  20. Portier F, Defouilloy C, Muir JF. Determinants of immediate survival among chronic respiratory insufficiency patients admitted to an intensive care unit for acute respiratory failure. A prospective multicenter study. The French Task Group for Acute Respiratory Failure in Chronic Respiratory insufficiency. Chest 1992;101:204-10.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.