• Louis-Marie Galerneau, Sébastien Bailly, Nicolas Terzi, Stéphane Ruckly, Maité Garrouste-Orgeas, Yves Cohen, Hong Tuan HaVivienVMedical Intensive Care Unit, Meaux Hospital, Meaux, France., Marc Gainnier, Shidasp Siami, Claire Dupuis, Michael Darmon, Jean-Marie Forel, Guillaume Rigault, Christophe Adrie, Dany Goldgran-Toledano, Virginie Laurent, Etienne de Montmollin, Laurent Argaud, Jean Reignier, Jean-Louis Pepin, Jean-François Timsit, and OUTCOMEREA Network.
• Medical Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France.
• Crit. Care Med. 2023 Jun 1; 51 (6): 753764753-764.

ObjectivesOur aim was to describe changes in the management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) by ICUs and patient outcomes.DesignWe extracted data from the OutcomeRea database concerning patients admitted for AECOPD between 1997 and 2018. We analyzed trends in the use of ventilatory support, corticosteroid therapy, antibiotic therapy, and patient survival.SettingICUs at 32 French sites.PatientsOne thousand eight hundred sixteen patients in the database had a diagnosis of AECOPD.InterventionsNone.Measurements And Main ResultsOver time, there was a reduction in the prescription of corticosteroids and antibiotics. In a time-series analysis, these changes in practice were not linked with ICU mortality. The proportion of patients treated with invasive mechanical ventilation (IMV) also gradually declined (from 51% between 1997 and 2002 to 35% between 2013 and 2018) with an association between decrease in IMV use and reduction in ICU mortality in a time series analysis. Rates of noninvasive ventilation (NIV) failure decreased with an increase in NIV use to support weaning from IMV. There was a reduction in the median ICU length of stay (from 8 d in 1997-2002 to 4 d in 2013-2018) and in the median total duration of hospitalization (from 23 d in 1997-2002 to 14 d in 2013-2018). We observed an improvement in prognosis, with decreases in overall hospital mortality (from 24% between 1997 and 2002 to 15% between 2013 and 2018), ICU mortality (from 14% between 1997 and 2002 to 10% between 2013 and 2018), and 90-day mortality (from 41% between 1997 and 2002 to 22% between 2013 and 2018).ConclusionsThe length of stay and mortality of patients with AECOPD admitted to ICUs has decreased over the last 20 years, with a wider use of NIV and a reduction in antibiotic and corticosteroid prescriptions.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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