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Krishnan A, Ellis P, Antoine-Pitterson P, Oakes A, Jones B, Turner A, Mukherjee R. Long-Term Mortality following Acute Noninvasive Ventilation for Obesity-Related Respiratory Failure: A Retrospective Single-Centre Study. Can Respir J 2023; 2023:5370197. [PMID: 37868785 PMCID: PMC10586910 DOI: 10.1155/2023/5370197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/25/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Determinants of long-term mortality following acute hypercapnic respiratory failure have been extensively studied in patients with chronic obstructive pulmonary disease. However, respiratory failure due to obesity has not been studied to the same extent. This retrospective survey aims to identify whether admission pH is associated with long-term mortality in patients requiring acute noninvasive ventilation (NIV) for obesity-related respiratory failure (ORRF). Methods Records from April 2013 to March 2020 were accessed from a NIV quality database at an acute teaching hospital. Adults with hypercapnic ORRF requiring acute NIV were included. pH data were grouped by threshold (pH≤ and >7.25) and correlated with time from presentation to death; multivariable analysis was performed using Cox proportional hazards. Results A total of 277 acute NIV episodes were included. Two-year mortality was similar for patients in both pH categories. Univariable analysis identified pH ≤ 7.25 to increase risk of two-year mortality by 43%. However, multivariable analysis identified that pH was not a significant determinant of long-term mortality, although male sex, older age, and higher admission pCO2 increased the risk of death at two years by 76%, 3% per year of age, and 16% per 1 kPa of pCO2 increase, respectively. Conclusion Severity of hypercapnia on admission, male sex, and older age are associated with worse two-year mortality in patients requiring acute NIV for ORRF. There is scope for further analyses including investigating the role of domiciliary NIV in ORRF patients.
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Affiliation(s)
- Aditya Krishnan
- Institute of Applied Health Research, University of Birmingham, Birmingham, ENG, UK
| | - Paul Ellis
- Institute of Applied Health Research, University of Birmingham, Birmingham, ENG, UK
| | - Pearlene Antoine-Pitterson
- Department of Respiratory Medicine, Heartlands Hospital (Part of University Hospitals Birmingham), Birmingham, ENG, UK
| | - Amy Oakes
- Department of Respiratory Medicine, Heartlands Hospital (Part of University Hospitals Birmingham), Birmingham, ENG, UK
| | - Bethany Jones
- Department of Respiratory Medicine, Heartlands Hospital (Part of University Hospitals Birmingham), Birmingham, ENG, UK
| | - Alice Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, ENG, UK
- Department of Respiratory Medicine, Heartlands Hospital (Part of University Hospitals Birmingham), Birmingham, ENG, UK
| | - Rahul Mukherjee
- Department of Respiratory Medicine, Heartlands Hospital (Part of University Hospitals Birmingham), Birmingham, ENG, UK
- Institute of Clinical Sciences, University of Birmingham, Birmingham, ENG, UK
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Mendonça Almeida L, Jacob M, Van Zeller M, Pinto T, Gonçalves M, Drummond M. Non-invasive ventilation in the elderly - never too late! Monaldi Arch Chest Dis 2021; 91. [PMID: 33794594 DOI: 10.4081/monaldi.2021.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/24/2021] [Indexed: 11/23/2022] Open
Abstract
Dear Editor, Practising evidence-based medicine in an ageing population is challenging. Nevertheless, using age as a diagnostic or therapeutic procedure contraindication is less and less common. Domiciliary non-invasive ventilation (NIV) in chronic respiratory failure patients has been largely used; however, data from older people is scarce...
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Affiliation(s)
| | - Maria Jacob
- Pulmonology Department, Centro Hospitalar Universitário São João.
| | - Mafalda Van Zeller
- Sleep and Non-invasive Ventilation Unit, Centro Hospitalar Universitário São João.
| | - Tiago Pinto
- Sleep and Non-invasive Ventilation Unit, Centro Hospitalar Universitário São João.
| | - Miguel Gonçalves
- Pulmonology Department, Centro Hospitalar Universitário São João.
| | - Marta Drummond
- Sleep and Non-invasive Ventilation Unit, Centro Hospitalar Universitário São João.
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Difficulties experienced by geriatric patients regarding respiratory devices and access to health services: A cross-sectional study. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.869150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cantero C, Adler D, Pasquina P, Uldry C, Egger B, Prella M, Younossian AB, Soccal-Gasche P, Pépin JL, Janssens JP. Long-Term Non-invasive Ventilation: Do Patients Aged Over 75 Years Differ From Younger Adults? Front Med (Lausanne) 2020; 7:556218. [PMID: 33262990 PMCID: PMC7686650 DOI: 10.3389/fmed.2020.556218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/22/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Noninvasive ventilation (NIV) is accepted as standard of care for chronic hypercapnic respiratory failure (CHRF) and is being increasingly implemented in older subjects. However, little is known regarding the use of NIV on a long-term basis in the very old. The outcomes of this study were: 1/to report the proportion of patients ≥ 75 years old (elderly) among a large group of long-term NIV users and its trend since 2000; 2/to compare this population to a younger population (<75 years old) under long-term NIV in terms of diagnoses, comorbidities, anthropometric data, technical aspects, adherence to and efficiency of NIV. Methods: In a cross-sectional analysis of a multicenter cohort study on patients with CHRF under NIV, diagnoses, comorbidities, technical aspects, adherence to and efficiency of NIV were compared between patients ≥ 75 and <75 years old (chi-square or Welch Student tests). Results: Of a total of 489 patients under NIV, 151 patients (31%) were ≥ 75 years of age. Comorbidities such as systemic hypertension (86 vs. 60%, p < 0.001), chronic heart failure (30 vs. 18%, p = 0.005), and pulmonary hypertension (25 vs. 14%, p = 0.005) were more frequent in older subjects. In the older group, there was a trend for a higher prevalence of chronic obstructive pulmonary disease (COPD) (46 vs. 36%, p = 0.151) and a lower prevalence of neuromuscular diseases (NMD) (19 vs. 11%, p = 0.151), although not significant. Adherence to and efficacy of NIV were similar in both groups (daily use of ventilator: 437 vs. 419 min, p = 0.76; PaCO2: 5.8 vs. 5.9 kPa, p = 0.968). Unintentional leaks were slightly higher in the older group (1.8 vs. 0.6 L/min, p = 0.018). Conclusions: In this cross-sectional study, one third of the population under NIV was ≥ 75 years old. Markers of efficacy of NIV, and adherence to treatment were similar when compared to younger subjects, confirming the feasibility of long-term NIV in the very old. Health-related quality of life was not assessed in this study and further research is needed to address this issue.
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Affiliation(s)
- Chloé Cantero
- Division of Pulmonary Diseases, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospitals (HUG), Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Patrick Pasquina
- Division of Pulmonary Diseases, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Christophe Uldry
- Division of Pulmonary Diseases and Pulmonary Rehabilitation Center, Rolle Hospital Rolle, Vaud, Switzerland
| | - Bernard Egger
- Division of Pulmonary Diseases and Pulmonary Rehabilitation Center, Rolle Hospital Rolle, Vaud, Switzerland
| | - Maura Prella
- Division of Pulmonary Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Alain Bigin Younossian
- Division of Pulmonary Diseases and Intensive Care, La Tour Hospital, Geneva, Switzerland
| | - Paola Soccal-Gasche
- Division of Pulmonary Diseases, Geneva University Hospitals (HUG), Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Louis Pépin
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals (HUG), Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Le Grice K, Shah NM, Bunce C, Suh ES. The generalizability of randomized controlled trials investigating non-invasive ventilation in patients with COPD. Respirology 2020; 25:1031-1032. [PMID: 32436326 DOI: 10.1111/resp.13849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Kathryn Le Grice
- Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Neeraj M Shah
- Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Catey Bunce
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Eui-Sik Suh
- Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Medicine, King's College London, London, UK
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Egea-Santaolalla CJ, Chiner Vives E, Díaz Lobato S, Mangado NG, Lujan Tomé M, Mediano San Andrés O. Ventilación mecánica a domicilio. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2020.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Ocaklı B. The Feasibility of Domiciliary Non-Invasive Mechanical Ventilation due to Chronic Respiratory Failure in Very Elderly Patients. Turk Thorac J 2019; 20:130-135. [PMID: 30958986 PMCID: PMC6453630 DOI: 10.5152/turkthoracj.2018.18119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/13/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the use of domiciliary non-invasive mechanical ventilation (NIMV) in very elderly patients (age 80 and over). MATERIALS AND METHODS This retrospective study included a total of 44 patients aged 80 years or older, who were admitted to the Health Sciences University, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Pulmonary Intensive Care Outpatient Clinic between 2012 and 2018 and applied NIMV for chronic respiratory failure. The patients were divided into two groups: survivors (n=15) and non-survivors (n=29). Data were obtained from the retrospectively formed hospital database. The characteristics of patients, comorbidities, NIMV compliance, pulmonary function tests, and blood gas analyses were compared between the survivors and non-survivors. RESULTS From the retrospective analysis of 44 cases, the non-survivors were found to have a significantly shorter duration of domiciliary NIMV (737 days vs. 890 days, p=0.027) and lower hemoglobin concentration (11.1 g/L vs. 12.9 g/L, p=0.004). The number of comorbid conditions, pulmonary function test, and blood gas analyses results did not differ significantly between the groups. Compliance was moderate in this elderly population, at 4.9±1.9 h/day (range: 0.8-9.1 h/day). NIMV was well-tolerated in 36 of the 44 elderly patients (81.8%). Overall mortality was 65.9%. CONCLUSION Domiciliary NIMV can be of benefit to very elderly patients, and age is not an obstacle. Therefore, this population should not be excluded from this treatment solely on the basis of age.
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Affiliation(s)
- Birsen Ocaklı
- Intensive Care Unit, Health Sciences University, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
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MacIntyre EJ, Asadi L, Mckim DA, Bagshaw SM. Clinical Outcomes Associated with Home Mechanical Ventilation: A Systematic Review. Can Respir J 2016; 2016:6547180. [PMID: 27445559 PMCID: PMC4904519 DOI: 10.1155/2016/6547180] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/23/2015] [Indexed: 11/18/2022] Open
Abstract
Background. The prevalence of patients supported with home mechanical ventilation (HMV) for chronic respiratory failure has increased. However, the clinical outcomes associated with HMV are largely unknown. Methods. We performed a systematic review of studies evaluating patients receiving HMV for indications other than obstructive lung disease, reporting at least one clinically relevant outcome including health-related quality of life (HRQL) measured by validated tools; hospitalization requirements; caregiver burden; and health service utilization. We searched MEDLINE, EMBASE, CINAHL, the Cochrane library, clinical trial registries, proceedings from selected scientific meetings, and bibliographies of retrieved citations. Results. We included 1 randomized control trial (RCT) and 25 observational studies of mixed methodological quality involving 4425 patients; neuromuscular disorders (NMD) (n = 1687); restrictive thoracic diseases (RTD) (n = 481); obesity hypoventilation syndrome (OHS) (n = 293); and others (n = 748). HRQL was generally described as good for HMV users. Mental rather than physical HRQL domains were rated higher, particularly where physical assessment was limited. Hospitalization rates and days in hospital appear to decrease with implementation of HMV. Caregiver burden associated with HMV was generally high; however, it is poorly described. Conclusion. HRQL and need for hospitalization may improve after establishment of HMV. These inferences are based on relatively few studies of marked heterogeneity and variable quality.
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Affiliation(s)
- Erika J. MacIntyre
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada T6G 2B7
| | - Leyla Asadi
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada T6G 2R3
| | - Doug A. Mckim
- Division of Respirology and Respiratory Rehabilitation Services, Faculty of Medicine and Dentistry, University of Ottawa, Ottawa, ON, Canada T6G 2R3
| | - Sean M. Bagshaw
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada T6G 2B7
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada T6G 2R3
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Hodgson LE, Murphy PB. Update on clinical trials in home mechanical ventilation. J Thorac Dis 2016; 8:255-67. [PMID: 26904266 PMCID: PMC4739968 DOI: 10.3978/j.issn.2072-1439.2016.01.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/30/2015] [Indexed: 12/14/2022]
Abstract
Home mechanical ventilation (HMV) is an increasingly common intervention and is initiated for a range of pathological processes, including neuromuscular disease (NMD), chronic obstructive pulmonary disease (COPD) and obesity related respiratory failure. There have been important recent data published in this area, which helps to guide practice by indicating which populations may benefit from this intervention and the optimum method of setting up and controlling sleep disordered breathing. Recent superficially conflicting data has been published regarding HMV in COPD, with a trial in post-exacerbation patients suggesting no benefit, but in stable chronic hypercapnic patients suggesting a clear and sustained mortality benefit. The two studies are critiqued and the potential reasons for the differing results are discussed. Early and small trial data is frequently contradicted with larger randomised controlled trials and this has been the case with diaphragm pacing being shown to be potentially harmful in the latest data, confirming the importance of non-invasive ventilation (NIV) in NMD such as motor neurone disease. Advances in ventilator technology have so far appeared quicker than the clinical data to support their use; although small and often unblinded, the current data suggests equivalence to standard modes of NIV, but with potential comfort benefits that may enhance adherence. The indications for NIV have expanded since its inception, with an effort to treat sleep disordered breathing as a result of chronic heart failure (HF). The SERVE-HF trial has recently demonstrated no clear advantage to this technology and furthermore detected a potentially deleterious effect, with a worsening of all cause and cardiovascular mortality in the treated group compared to controls. The review serves to provide the reader with a critical review of recent advances in the field of sleep disordered breathing and HMV.
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Tissot A, Jaffre S, Gagnadoux F, Levaillant M, Corne F, Chollet S, Blanc FX, Goupil F, Priou P, Trzepizur W, Magnan A. Home Non-Invasive Ventilation Fails to Improve Quality of Life in the Elderly: Results from a Multicenter Cohort Study. PLoS One 2015; 10:e0141156. [PMID: 26489014 PMCID: PMC4619542 DOI: 10.1371/journal.pone.0141156] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/03/2015] [Indexed: 11/29/2022] Open
Abstract
Background Home non-invasive ventilation (NIV) is a widely used treatment for chronic hypoventilation but little is known on its impact in the elderly. In a multicenter prospective cohort study, we studied tolerance and efficacy of domiciliary NIV in patients aged 75 or more compared to younger ones. Methods and Results 264 patients with at least a six-month follow-up were analyzed. Among them, 82 were elderly. In the elderly and the younger, we found an improvement of arterial blood gas, the Epworth sleepiness scale and the Pittsburgh sleep quality index at 6 months. Mean daily use of NIV at 6 months was 7 hours and the rate of non-adherent patients was similar in both group. Health-related quality of life (HRQL) assessed by SF-36 questionnaires did not change significantly after NIV initiation in the elderly whereas HRQL improved in the less than 75. On univariate analysis, we found that diabetes was a predictive factor for non-adherence in the elderly (Odds ratio: 3.95% confidence interval: 1.06–8.52). Conclusion NIV was efficient in the elderly while evaluation at 6 months showed a good adherence but failed to improve HRQL.
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Affiliation(s)
- Adrien Tissot
- Service de pneumologie, L'institut du thorax, CHU Nantes, Nantes, France
- * E-mail:
| | - Sandrine Jaffre
- Service de pneumologie, L'institut du thorax, CHU Nantes, Nantes, France
| | | | | | - Frédéric Corne
- Service de pneumologie, L'institut du thorax, CHU Nantes, Nantes, France
| | - Sylvaine Chollet
- Service de pneumologie, L'institut du thorax, CHU Nantes, Nantes, France
| | | | - François Goupil
- Service de Pneumologie, Centre Hospitalier du Mans, Le Mans, France
| | | | | | - Antoine Magnan
- Service de pneumologie, L'institut du thorax, CHU Nantes, Nantes, France
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Abstract
The Hedgehog (Hh) signalling pathway plays many important roles in development, homeostasis and tumorigenesis. The critical function of Hh signalling in bone formation has been identified in the past two decades. Here, we review the evolutionarily conserved Hh signalling mechanisms with an emphasis on the functions of the Hh signalling pathway in bone development, homeostasis and diseases. In the early stages of embryonic limb development, Sonic Hedgehog (Shh) acts as a major morphogen in patterning the limb buds. Indian Hedgehog (Ihh) has an essential function in endochondral ossification and induces osteoblast differentiation in the perichondrium. Hh signalling is also involved intramembrane ossification. Interactions between Hh and Wnt signalling regulate cartilage development, endochondral bone formation and synovial joint formation. Hh also plays an important role in bone homeostasis, and reducing Hh signalling protects against age-related bone loss. Disruption of Hh signalling regulation leads to multiple bone diseases, such as progressive osseous heteroplasia. Therefore, understanding the signalling mechanisms and functions of Hh signalling in bone development, homeostasis and diseases will provide important insights into bone disease prevention, diagnoses and therapeutics.
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Britto RR, Vieira DSR, Botoni FA, Botoni ALAS, Velloso M. The Presentation of Respiratory Failure in Elderly Individuals. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0130-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Escarrabill J, Tebé C, Espallargues M, Torrente E, Tresserras R, Argimón J. Variability in home mechanical ventilation prescription. Arch Bronconeumol 2015; 51:490-5. [PMID: 25618455 DOI: 10.1016/j.arbres.2014.11.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Few studies have analyzed the prevalence and accessibility of home mechanical ventilation (HMV). The aim of this study was to characterize the prevalence of HMV and variability in prescriptions from administrative data. METHODS Prescribing rates of HMV in the 37 healthcare sectors of the Catalan Health Service were compared from billing data from 2008 to 2011. Crude accumulated activity rates (per 100,000 population) were calculated using systematic component of variation (SCV) and empirical Bayes (EB) methods. Standardized activity ratios (SAR) were described using a map of healthcare sectors. RESULTS A crude rate of 23 HMV prescriptions per 100,000 population was observed. Rates increase with age and have increased by 39%. Statistics measuring variation not due to chance show a high variation in women (CSV=0.20 and EB=0.30) and in men (CSV=0.21 and EB=0.40), and were constant over time. In a multilevel Poisson model, hospitals with a chest unit were associated with a greater number of cases (beta=0.68, P<.0001). CONCLUSIONS High variability in prescribing HMV can be explained, in part, by the attitude of professionals towards treatment and accessibility to specialist centers with a chest unit. Analysis of administrative data and variability mapping help identify unexplained variations and, in the absence of systematic records, are a feasible way of tracking treatment.
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Affiliation(s)
- Joan Escarrabill
- Hospital Clínic, Barcelona, España; Plan Director de las Enfermedades del Aparato Respiratorio (PDMAR), Barcelona, España; Observatorio de las Terapias Respiratorias (Obs TRD). Departamento de Salud, CatSalut, AQuAS, PDMAR y Fundació d'Osona per a la Recerca i Educació Sanitària (FORES), Vic, Barcelona, España; REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas), Barcelona, España.
| | - Cristian Tebé
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España; REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas), Barcelona, España
| | - Mireia Espallargues
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España; REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas), Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, España
| | - Elena Torrente
- Plan Director de las Enfermedades del Aparato Respiratorio (PDMAR), Barcelona, España; Departamento de Salud (Generalitat de Catalunya), Barcelona, España
| | - Ricard Tresserras
- Plan Director de las Enfermedades del Aparato Respiratorio (PDMAR), Barcelona, España; Departamento de Salud (Generalitat de Catalunya), Barcelona, España
| | - J Argimón
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España
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Esquinas Rodríguez AM, Zamarro García C. Ventilación mecánica no invasiva en pacientes de edad avanzada: ¿hacia una nueva estrategia de organización hospitalaria? Arch Bronconeumol 2013; 49:275-6. [DOI: 10.1016/j.arbres.2012.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 11/23/2012] [Accepted: 11/23/2012] [Indexed: 10/27/2022]
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Stone RA, Lowe D, Potter JM, Buckingham RJ, Roberts CM, Pursey NJ. Managing patients with COPD exacerbation: does age matter? Age Ageing 2012; 41:461-8. [PMID: 22454133 DOI: 10.1093/ageing/afs039] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION there is little information about the relationship between age and management of COPD exacerbation (AECOPD), although older persons are known to be at a greater risk of hospital admission. METHODS we have investigated responses from the clinical and patient questionnaire elements of the 2008 UK COPD audit, splitting the data into age decile. RESULTS age ranged from 27 to 102. Patient-reported data suggested older patients had inferior knowledge of COPD, undertook less self-care and were less likely to recognise symptoms of exacerbation prior to hospitalisation. Clinician-reported data showed that although older patients had severe disease and symptoms, greater co-morbidity at presentation and higher mortality, fewer were seen in hospital or followed up subsequently by respiratory specialists. Older patients were more likely to have a DNR order signed within 24 h of admission, irrespective of co-morbidities or performance status. The observations were particularly applicable to those aged 80 or above. CONCLUSIONS clinicians should consider increasing age as a specific risk factor in the management of COPD. Acute units and community teams should review carefully their protocols and pathways for how they assess, manage, discharge and follow-up older patients with COPD exacerbation.
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Affiliation(s)
- Robert A Stone
- Clinical Standards Department, Royal College of Physicians, 11 St Andrews Place Regents Park, London NW1 4LE, UK.
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Dellborg C, Olofson J, Midgren B, Caro O, Bergman B, Skoogh BE, Sullivan M. Impact of home mechanical ventilation on health-related quality of life in patients with chronic alveolar hypoventilation: a prospective study. CLINICAL RESPIRATORY JOURNAL 2010; 2:26-35. [PMID: 20298301 DOI: 10.1111/j.1752-699x.2007.00034.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Nocturnal ventilatory support by nasal positive pressure ventilation (NPPV) is an established treatment method in patients with chronic alveolar hypoventilation (CAH). The knowledge about its long-term effects on health-related quality of life (HRQL) is limited. METHODS In a prospective, longitudinal, single-strand study, patients with CAH caused by non-COPD conditions, consecutively recruited among referral patients in three Swedish university hospital pulmonary departments, were examined at baseline and after 9 months (n = 35) and 8 years (n = 11) on NPPV treatment. Both volume pre-set and pressure pre-set ventilators were used. Patients completed a battery of condition-specific and generic HRQL questionnaires at baseline and follow-up. Spirometry and blood gases were measured. Compliance with treatment, side effects and patient satisfaction were evaluated. RESULTS After 9 months of NPPV, improvements were seen primarily not only in sleep-related domains, but also in emotional behaviour, ambulation and sleep/rest functioning as measured with the Sickness Impact Profile (SIP). Improvements in sleep-related symptoms were related to effectiveness in ventilation, evaluated by morning PaCO(2), and remained by 8 years. Mental well-being was stable over time, while emotional distress improved by 8 years. Satisfaction with treatment was high in spite of frequent side effects. CONCLUSION NPPV improves HRQL, particularly in condition-specific areas. Improvements are related to effectiveness in ventilation. Side effects are common, but compliance is good and patient satisfaction is high.
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Affiliation(s)
- Catharina Dellborg
- Department of Respiratory Medicine and Allergology, Institute of Medicine, Sahlgrenska Academy at Göteborg University, Sweden
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Olofson J, Dellborg C, Sullivan M, Midgren B, Caro O, Bergman B. Qualify of life and palliation predict survival in patients with chronic alveolar hypoventilation and nocturnal ventilatory support. Qual Life Res 2009; 18:273-80. [PMID: 19219411 DOI: 10.1007/s11136-009-9445-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 01/22/2009] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Non-invasive positive pressure ventilation (NPPV) improves health-related quality of life (HRQL) in patients with chronic alveolar hypoventilation (CAH). We studied the prognostic impact of HRQL on survival in relation to clinical factors. PATIENTS Forty-four patients with CAH due to post-polio (12), scoliosis (11), post-tb (17) or other diagnoses (4) who received nocturnal NPPV were prospectively studied during 6-10 years. MEASUREMENTS Blood gases and HRQL were analysed at baseline and after 9 months and after 8 years. HRQL was evaluated with measures of functioning (SIP), emotional well-being (HADS and MACL), and global QL. RESULTS Blood gases and HRQL measures improved during NPPV. The overall 5-year survival rate was 73%. In multivariate survival analysis, a diagnosis of post-polio and low baseline SIP physical index scores, indicating low levels of physical dysfunction, predicted longer survival (P = 0.02, respectively). Similarly, palliation of physical dysfunction and preserved or improved global QL by 9 months were associated with longer overall survival (P = 0.009 and P = 0.001, respectively; multivariate Cox regression). CONCLUSION Seventy-three percent of patients treated for CAH with NPPV survived more than 5 years. Diagnosis and self-rated physical functioning at pre-treatment were related to survival, as were major improvements in physical functioning and global QL during NPPV.
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Affiliation(s)
- Jan Olofson
- Department of Respiratory Medicine and Allergology, Institute of Medicine, Sahlgrenska University Hospital, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, 413 45, Sweden.
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Midgren B. Home mechanical ventilation. A growing challenge in an aging society. Respir Med 2007; 101:1066-7. [PMID: 17107779 DOI: 10.1016/j.rmed.2006.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Accepted: 10/03/2006] [Indexed: 12/01/2022]
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