(1167) Nebulized Treatment Strategies in Patients Admitted to the ICU With Acute Exacerbations of COPD

Introduction: Acute exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) are essential events in individuals with this condition because they have a detrimental effect on several outcomes (1, 2). Standard of care includes short-acting bronchodilators (SABD) as the initial treatment of choice in hospitalized patients and resuming home regimen during hospitalization or before hospital discharge (3). However, this is difficult in patients who are in the intensive care unit (ICU) and on mechanical ventilation (MV). The use of nebulized long-acting beta-agonists (LABA) and inhaled corticosteroids (ICS) in this patient population has not yet been evaluated; our aim was to determine if these therapies improve outcomes.

Methods: This was a retrospective chart review of adults admitted to the ICU with AECOPD between January 2014 and December 2020. We included patients > 18 years of age and with confirmed COPD with pulmonary function tests. The primary outcome was ICU length of stay (LOS). Secondary outcomes included days on MV, rate of invasive MV, and in-hospital mortality.

Frequency and descriptive statistics were used to describe the demographic and clinical characteristics of the sample. Continuous outcomes (ICU LOS and days on MV) were compared using non-parametric Mann-Whitney U tests (medians were reported for the groups). Chi-square analysis was used to determine the difference between the rate of MV and in-hospital mortality, and frequency and percentage statistics were reported for those analyses.

Results: The study included 218 patients; 133 were treated with SABD alone (Group A), and 85 were treated with a combination SABD and LABA/ICS (Group B). Their mean age was 65 years, 51% were female, the mean FEV1 was 42%, and the mean Charlson comorbidity score was five.

There were no differences in ICU LOS (3 vs 3, p=0.85), endotracheal intubation (34% vs 28%; p=0.39), and mortality (9% vs 8%; p=0.73) between groups A and B respectively. MV days were lower in group A compared to B (1 vs 2; p=0.015).

Conclusions: Adding nebulized LABA/ICS to SABD was not associated with improved outcomes despite the increased burden and cost that the patients and staff experience (4). Use of SABD alone was associated with fewer days on MV. More studies are needed to corroborate the results of our retrospective study.