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Schmidt M, Demoule A, Deslandes-Boutmy E, Chaize M, de Miranda S, Bèle N, Roche N, Azoulay E, Similowski T. Intensive care unit admission in chronic obstructive pulmonary disease: patient information and the physician's decision-making process. Crit Care 2014; 18:R115. [PMID: 24898342 PMCID: PMC4229873 DOI: 10.1186/cc13906] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 05/20/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION ICU admission is required in more than 25% of patients with chronic obstructive pulmonary disease (COPD) at some time during the course of the disease. However, only limited information is available on how physicians communicate with COPD patients about ICU admission. METHODS COPD patients and relatives from 19 French ICUs were interviewed at ICU discharge about their knowledge of COPD. French pulmonologists self-reported their practices for informing and discussing intensive care treatment preferences with COPD patients. Finally, pulmonologists and ICU physicians reported barriers and facilitators for transfer of COPD patients to the ICU and to propose invasive mechanical ventilation. RESULTS Self-report questionnaires were filled in by 126 COPD patients and 102 relatives, and 173 pulmonologists and 135 ICU physicians were interviewed. For 41% (n = 39) of patients and 54% (n = 51) of relatives, ICU admission had never been expected prior to admission. One half of patients were not routinely informed by their pulmonologist about possible ICU admission at some time during the course of COPD. Moreover, treatment options (that is, non-invasive ventilation, intubation and mechanical ventilation or tracheotomy) were not explained to COPD patients during regular pulmonologist visits. Pulmonologists and ICU physician have different perceptions of the decision-making process pertaining to ICU admission and intubation. CONCLUSIONS The information provided by pulmonologists to patients and families concerning the prognosis of COPD, the risks of ICU admission and specific care could be improved in order to deliver ICU care in accordance with the patient's personal values and preferences. Given the discrepancies in the decision-making process between pulmonologists and intensivists, a more collaborative approach should probably be discussed.
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Affiliation(s)
- Matthieu Schmidt
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 ‘Neurophysiologie Respiratoire Expérimentale et Clinique’, 47-83 boulevard de l'Hôpital, 75013 Paris, France
- INSERM, UMR_S 1158 ‘Neurophysiologie Respiratoire Expérimentale et Clinique’, 47-83 boulevard de l'Hôpital, 75013 Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département ‘R3S’), 47 boulevard de l'Hôpital, F-75013 Paris, France
| | - Alexandre Demoule
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département ‘R3S’), 47 boulevard de l'Hôpital, F-75013 Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 974, 47-83 boulevard de l'Hôpital, 75013 Paris, France
- INSERM, UMR_S 974, F-75005 Paris, France
| | - Emmanuelle Deslandes-Boutmy
- Hôpitaux de Paris, Hôpital Saint Louis, Service de Biostatistique, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Marine Chaize
- Hôpitaux de Paris, Hôpital Saint Louis, Service de Réanimation Médicale, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Sandra de Miranda
- Hôpitaux de Paris, Hôpital Saint Louis, Service de Réanimation Médicale, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Nicolas Bèle
- Hôpitaux de Paris, Hôpital Saint Louis, Service de Réanimation Médicale, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Nicolas Roche
- Hôpitaux de Paris, Hôpital Cochin – Site Val de Grâce, Service de Pneumologie et Soins Intensifs Respiratoires, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, F-75014 Paris, France
| | - Elie Azoulay
- Hôpitaux de Paris, Hôpital Saint Louis, Service de Réanimation Médicale, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 ‘Neurophysiologie Respiratoire Expérimentale et Clinique’, 47-83 boulevard de l'Hôpital, 75013 Paris, France
- INSERM, UMR_S 1158 ‘Neurophysiologie Respiratoire Expérimentale et Clinique’, 47-83 boulevard de l'Hôpital, 75013 Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département ‘R3S’), 47 boulevard de l'Hôpital, F-75013 Paris, France
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Incalzi RA, Scarlata S, Pennazza G, Santonico M, Pedone C. Chronic Obstructive Pulmonary Disease in the elderly. Eur J Intern Med 2014; 25:320-8. [PMID: 24183233 DOI: 10.1016/j.ejim.2013.10.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 06/21/2013] [Accepted: 10/04/2013] [Indexed: 11/21/2022]
Abstract
The prevalence of Chronic Obstructive Pulmonary Disease (COPD) dramatically increases with age, and COPD complicated by chronic respiratory failure may be considered a geriatric condition. Unfortunately, most cases remain undiagnosed because of atypical clinical presentation and difficulty with current respiratory function diagnostic standards. Accordingly, the disease is under-recognized and undertreated. This is expected to impact noticeably the health status of unrecognized COPD patients because a timely therapy could mitigate the distinctive and important effects of COPD on the health status. Comorbidity also plays a pivotal role in conditioning both the health status and the therapy of COPD besides having major prognostic implication. Several problems affect the overall quality of the therapy for the elderly with COPD, and current guidelines as well as results from pharmacological trials only to some extent apply to this patient. Finally, physicians of different specialties care for the elderly COPD patient: physician's specialty largely determines the kind of approach. In conclusion, COPD, in itself a complex disease, becomes difficult to identify and to manage in the elderly. Interdisciplinary efforts are desirable to provide the practicing physician with a multidisciplinary guide to the identification and treatment of COPD.
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Affiliation(s)
- Raffaele Antonelli Incalzi
- Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio-Medico University and Teaching Hospital, Rome, Italy; San Raffaele - Cittadella della Carità Foundation, Taranto, Italy.
| | - Simone Scarlata
- Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Giorgio Pennazza
- Center for Integrated Research - CIR, Unit of Electronics for Sensor Systems, Campus Bio-Medico University, Rome, Italy
| | - Marco Santonico
- Center for Integrated Research - CIR, Unit of Electronics for Sensor Systems, Campus Bio-Medico University, Rome, Italy
| | - Claudio Pedone
- Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
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