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Liao KM, Lu HY, Chen CY, Kuo LT, Tang BR. The impact of comorbidities on prolonged mechanical ventilation in patients with chronic obstructive pulmonary disease. BMC Pulm Med 2024; 24:257. [PMID: 38796444 PMCID: PMC11128105 DOI: 10.1186/s12890-024-03068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 05/20/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND In patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure, approximately 10% of them are considered to be at high risk for prolonged mechanical ventilation (PMV, > 21 days). PMV have been identified as independent predictors of unfavorable outcomes. Our previous study revealed that patients aged 70 years older and COPD severity were at a significantly higher risk for PMV. We aimed to analyze the impact of comorbidities and their associated risks in patients with COPD who require PMV. METHODS The data used in this study was collected from Kaohsiung Medical University Hospital Research Database. The COPD subjects were the patients first diagnosed COPD (index date) between January 1, 2012 and December 31, 2020. The exclusion criteria were the patients with age less than 40 years, PMV before the index date or incomplete records. COPD and non-COPD patients, matched controls were used by applying the propensity score matching method. RESULTS There are 3,744 eligible patients with COPD in the study group. The study group had a rate of 1.6% (60 cases) patients with PMV. The adjusted HR of PMV was 2.21 (95% CI 1.44-3.40; P < 0.001) in the COPD patients than in non-COPD patients. Increased risks of PMV were found significantly for patients with diabetes mellitus (aHR 4.66; P < 0.001), hypertension (aHR 3.20; P = 0.004), dyslipidemia (aHR 3.02; P = 0.015), congestive heart failure (aHR 6.44; P < 0.001), coronary artery disease (aHR 3.11; P = 0.014), stroke (aHR 6.37; P < 0.001), chronic kidney disease (aHR 5.81 P < 0.001) and Dementia (aHR 5.78; P < 0.001). CONCLUSIONS Age, gender, and comorbidities were identified as significantly higher risk factors for PMV occurrence in the COPD patients compared to the non-COPD patients. Beyond age, comorbidities also play a crucial role in PMV in COPD.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, Taiwan.
| | - Chung-Yu Chen
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Bo-Ren Tang
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, Taiwan
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2
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Tripipitsiriwat A, Suppapueng O, van Meenen DMP, Paulus F, Hollmann MW, Sivakorn C, Schultz MJ. Epidemiology, Ventilation Management and Outcomes of COPD Patients Receiving Invasive Ventilation for COVID-19-Insights from PRoVENT-COVID. J Clin Med 2023; 12:5783. [PMID: 37762725 PMCID: PMC10532133 DOI: 10.3390/jcm12185783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a risk factor for death in patients admitted to intensive care units (ICUs) for respiratory support. Previous reports suggested higher mortality in COPD patients with COVID-19. It is yet unknown whether patients with COPD were treated differently compared to non-COPD patients. We compared the ventilation management and outcomes of invasive ventilation for COVID-19 in COPD patients versus non-COPD patients. This was a post hoc analysis of a nation-wide, observational study in the Netherlands. COPD patients were compared to non-COPD patients with respect to key ventilation parameters. The secondary endpoints included adjunctive treatments for refractory hypoxemia, and 28-day mortality. Of a total of 1090 patients, 88 (8.1%) were classified as having COPD. The ventilation parameters were not different between COPD patients and non-COPD patients, except for FiO2, which was higher in COPD patients. Prone positioning was applied more often in COPD patients. COPD patients had higher 28-day mortality than non-COPD patients. COPD had an independent association with 28-day mortality. In this cohort of patients who received invasive ventilation for COVID-19, only FiO2 settings and the use of prone positioning were different between COPD patients and non-COPD patients. COPD patients had higher mortality than non-COPD patients.
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Affiliation(s)
- Athiwat Tripipitsiriwat
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Orawan Suppapueng
- Division of Clinical Epidemiology, Department of Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - David M. P. van Meenen
- Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands; (F.P.); (M.J.S.)
- Department of Anesthesiology, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands;
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands; (F.P.); (M.J.S.)
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1101 CD Amsterdam, The Netherlands
| | - Markus W. Hollmann
- Department of Anesthesiology, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands;
| | - Chaisith Sivakorn
- Intensive Care Unit, University College London Hospital, London NW1 2BU, UK;
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands; (F.P.); (M.J.S.)
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
- Department of Anesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Medical University of Vienna, 1090 Vienna, Austria
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Kosenko E, Tikhonova L, Alilova G, Montoliu C. Erythrocytes Functionality in SARS-CoV-2 Infection: Potential Link with Alzheimer's Disease. Int J Mol Sci 2023; 24:5739. [PMID: 36982809 PMCID: PMC10051442 DOI: 10.3390/ijms24065739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a rapidly spreading acute respiratory infection caused by SARS-CoV-2. The pathogenesis of the disease remains unclear. Recently, several hypotheses have emerged to explain the mechanism of interaction between SARS-CoV-2 and erythrocytes, and its negative effect on the oxygen-transport function that depends on erythrocyte metabolism, which is responsible for hemoglobin-oxygen affinity (Hb-O2 affinity). In clinical settings, the modulators of the Hb-O2 affinity are not currently measured to assess tissue oxygenation, thereby providing inadequate evaluation of erythrocyte dysfunction in the integrated oxygen-transport system. To discover more about hypoxemia/hypoxia in COVID-19 patients, this review highlights the need for further investigation of the relationship between biochemical aberrations in erythrocytes and oxygen-transport efficiency. Furthermore, patients with severe COVID-19 experience symptoms similar to Alzheimer's, suggesting that their brains have been altered in ways that increase the likelihood of Alzheimer's. Mindful of the partly assessed role of structural, metabolic abnormalities that underlie erythrocyte dysfunction in the pathophysiology of Alzheimer's disease (AD), we further summarize the available data showing that COVID-19 neurocognitive impairments most probably share similar patterns with known mechanisms of brain dysfunctions in AD. Identification of parameters responsible for erythrocyte function that vary under SARS-CoV-2 may contribute to the search for additional components of progressive and irreversible failure in the integrated oxygen-transport system leading to tissue hypoperfusion. This is particularly relevant for the older generation who experience age-related disorders of erythrocyte metabolism and are prone to AD, and provide an opportunity for new personalized therapies to control this deadly infection.
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Affiliation(s)
- Elena Kosenko
- Institute of Theoretical and Experimental Biophysics of Russian Academy of Sciences, 142290 Pushchino, Russia
| | - Lyudmila Tikhonova
- Institute of Theoretical and Experimental Biophysics of Russian Academy of Sciences, 142290 Pushchino, Russia
| | - Gubidat Alilova
- Institute of Theoretical and Experimental Biophysics of Russian Academy of Sciences, 142290 Pushchino, Russia
| | - Carmina Montoliu
- Hospital Clinico Research Foundation, INCLIVA Health Research Institute, 46010 Valencia, Spain
- Pathology Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
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4
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Chen D, Chen C, Zhang P, Zhang F, Zhang H, Sun Q, Sun J, Tan Y, Pan B, Wan X. The arrival ward requiring help by wheelchair or medical cart, arterial oxygenation index, age, albumin and neutrophil count score: Predicting in-hospital mortality in Chinese patients with acute exacerbations of chronic obstructive pulmonary disease. Chron Respir Dis 2023; 20:14799731231197226. [PMID: 37606249 PMCID: PMC10448383 DOI: 10.1177/14799731231197226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND In this study, we will derive and validate a prognostic tool to predict in-hospital death based on Chinese acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. METHODS Independent predictors of in-hospital death were identified by logistic regression analysis and incorporated into a clinical prediction tool. RESULTS The clinical prediction model was developed with data from 1121 patients and validated with data from 245 patients. The five predictors of in-hospital death from the development cohort (Arrival ward requiring help by wheelchair or medical cart, Arterial oxygenation index, Age, Albumin and Neutrophil count) were combined to form the AAAAN Score. The AAAAN Score achieved good discrimination (AUC = 0.85, 95% CI 0.81-0.89) and calibration (Hosmer-Lemeshow chi-square value was 3.33, p = 0.65). The AAAAN Score, which underwent internal bootstrap validation, also showed excellent discrimination for mortality (AUC = 0.85, 95% CI 0.81 to 0.89) and performed more strongly than other clinical prediction tools. Patients were categorized into 3 risk groups based on the scores: low risk (0-2 points, 0.7% in-hospital mortality), intermediate risk (3-4 points, 4.1% in-hospital mortality), and high risk (5-7 points, 23.4% in-hospital mortality). Predictive performance was confirmed by external validation. CONCLUSIONS The AAAAN Score is a prognostic tool to predict in-hospital death in Chinese AECOPD patients.
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Affiliation(s)
- Dawei Chen
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Caimei Chen
- Department of Nephrology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, China
| | - Pan Zhang
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng Zhang
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hao Zhang
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qing Sun
- Department of Nephrology, Sir Run Run Hospital Nanjing Medical University, Nanjing, China
| | - Jian Sun
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yan Tan
- Department of Respiratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Binbin Pan
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xin Wan
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Sullivan DR, Iyer AS, Enguidanos S, Cox CE, Farquhar M, Janssen DJA, Lindell KO, Mularski RA, Smallwood N, Turnbull AE, Wilkinson AM, Courtright KR, Maddocks M, McPherson ML, Thornton JD, Campbell ML, Fasolino TK, Fogelman PM, Gershon L, Gershon T, Hartog C, Luther J, Meier DE, Nelson JE, Rabinowitz E, Rushton CH, Sloan DH, Kross EK, Reinke LF. Palliative Care Early in the Care Continuum among Patients with Serious Respiratory Illness: An Official ATS/AAHPM/HPNA/SWHPN Policy Statement. Am J Respir Crit Care Med 2022; 206:e44-e69. [PMID: 36112774 PMCID: PMC9799127 DOI: 10.1164/rccm.202207-1262st] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Patients with serious respiratory illness and their caregivers suffer considerable burdens, and palliative care is a fundamental right for anyone who needs it. However, the overwhelming majority of patients do not receive timely palliative care before the end of life, despite robust evidence for improved outcomes. Goals: This policy statement by the American Thoracic Society (ATS) and partnering societies advocates for improved integration of high-quality palliative care early in the care continuum for patients with serious respiratory illness and their caregivers and provides clinicians and policymakers with a framework to accomplish this. Methods: An international and interprofessional expert committee, including patients and caregivers, achieved consensus across a diverse working group representing pulmonary-critical care, palliative care, bioethics, health law and policy, geriatrics, nursing, physiotherapy, social work, pharmacy, patient advocacy, psychology, and sociology. Results: The committee developed fundamental values, principles, and policy recommendations for integrating palliative care in serious respiratory illness care across seven domains: 1) delivery models, 2) comprehensive symptom assessment and management, 3) advance care planning and goals of care discussions, 4) caregiver support, 5) health disparities, 6) mass casualty events and emergency preparedness, and 7) research priorities. The recommendations encourage timely integration of palliative care, promote innovative primary and secondary or specialist palliative care delivery models, and advocate for research and policy initiatives to improve the availability and quality of palliative care for patients and their caregivers. Conclusions: This multisociety policy statement establishes a framework for early palliative care in serious respiratory illness and provides guidance for pulmonary-critical care clinicians and policymakers for its proactive integration.
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Sohal AS, Anand A, Kaur P, Kaur H, Attri JP. Prospective Comparative Evaluation of Noninvasive and Invasive Mechanical Ventilation in Patients of Chronic Obstructive Pulmonary Disease with Acute Respiratory Failure Type II. Anesth Essays Res 2021; 15:8-13. [PMID: 34667341 PMCID: PMC8462414 DOI: 10.4103/aer.aer_53_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/06/2021] [Accepted: 06/06/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Acute respiratory failure is a potential complication of chronic obstructive pulmonary disease (COPD) that severely affects the health of the patient and may require mechanical ventilation. We compared noninvasive and invasive mechanical ventilation in COPD patients with acute respiratory failure type II to validate clinical outcome based on biochemical analysis of arterial blood gases (ABGs) and pulmonary parameters in terms of duration of mechanical ventilation, period spent in intensive care unit (ICU) and mortality. Materials and Methods: After approval of institutional ethical committee 100 patients were selected for randomized prospective controlled trial and divided into two groups of 50 each according to mode of mechanical ventilation. Group-I patients managed with noninvasive ventilation (NIV) Group-ll managed with invasive ventilation. Results: Demographic data between two groups were comparable. ABG parameters were better at 2 h and 6 h interval in NIV as compared to invasive ventilation (P < 0.05). The duration of ventilation and total time spent in ICU was 106±10 hours and 168±8 hours respectively in NIV group and 218 ± 12 and 280 ± 20 in invasive group. On intergroup comparison these were significantly less in noninvasive group (P < 0.05). Hospital acquired pneumonia occurred in 10% of patients in invasive group whereas no incidence of pneumonia found in noninvasive group. Mortality rate was 12% in invasive groups and 2% in noninvasive groups. Conclusion: NIV leads to significant improvement in ABG and pulmonary parameters and it reduces duration of ventilation and total period of hospital stay so it can be used as an alternative to invasive ventilation as first-line treatment in COPD.
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Affiliation(s)
- Amartej Singh Sohal
- Department of Anaesthesia, Punjab Institute of Medical Sciences, Jalandhar, Punjab, India
| | - Asha Anand
- Department of Anaesthesia, Punjab Institute of Medical Sciences, Jalandhar, Punjab, India
| | - Prabhjot Kaur
- Department of SPM, Punjab Institute of Medical Sciences, Jalandhar, Punjab, India
| | - Harpreet Kaur
- Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India
| | - Joginder Pal Attri
- Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India
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7
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Phrenic nerve stimulation prevents diaphragm atrophy in patients with respiratory failure on mechanical ventilation. BMC Pulm Med 2021; 21:314. [PMID: 34625059 PMCID: PMC8500254 DOI: 10.1186/s12890-021-01677-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diaphragm atrophy and dysfunction is a major problem among critically ill patients on mechanical ventilation. Ventilator-induced diaphragmatic dysfunction is thought to play a major role, resulting in a failure of weaning. Stimulation of the phrenic nerves and resulting diaphragm contraction could potentially prevent or treat this atrophy. The subject of this study is to determine the effectiveness of diaphragm stimulation in preventing atrophy by measuring changes in its thickness. METHODS A total of 12 patients in the intervention group and 10 patients in the control group were enrolled. Diaphragm thickness was measured by ultrasound in both groups at the beginning of study enrollment (hour 0), after 24 hours, and at study completion (hour 48). The obtained data were then statistically analyzed and both groups were compared. RESULTS The results showed that the baseline diaphragm thickness in the interventional group was (1.98 ± 0.52) mm and after 48 hours of phrenic nerve stimulation increased to (2.20 ± 0.45) mm (p=0.001). The baseline diaphragm thickness of (2.00 ± 0.33) mm decreased in the control group after 48 hours of mechanical ventilation to (1.72 ± 0.20) mm (p<0.001). CONCLUSIONS Our study demonstrates that induced contraction of the diaphragm by pacing the phrenic nerve not only reduces the rate of its atrophy during mechanical ventilation but also leads to an increase in its thickness - the main determinant of the muscle strength required for spontaneous ventilation and successful ventilator weaning. TRIAL REGISTRATION The study was registered with ClinicalTrials.gov (18/06/2018, NCT03559933, https://clinicaltrials.gov/ct2/show/NCT03559933 ).
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8
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Characteristics and Outcomes of Critically Ill Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Australia and New Zealand. Ann Am Thorac Soc 2021; 17:736-745. [PMID: 32135066 DOI: 10.1513/annalsats.201911-821oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Rationale: The characteristics and outcomes of patients presenting with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring intensive care unit (ICU) admission are poorly understood and there are sparse epidemiological data.Objectives: The objectives were to describe epidemiology and outcomes of patients admitted to an ICU with COPD and to evaluate whether outcomes varied over time.Methods: We studied adult ICU admissions across Australia and New Zealand between 2005 and 2017 with a diagnosis of AECOPD and used an admission diagnosis of asthma as comparator for trends over time. We measured changes in characteristics and outcomes over time using logistic regression, adjusting for illness severity using the Australian New Zealand Risk of Death model.Results: We studied 31,991 admissions with AECOPD and 11,096 with asthma. Mean (standard deviation) age for AECOPD patients was 68.3 (11.2) years, with 35.4% mechanically ventilated. For patients with AECOPD, the percentage of deaths in an ICU was 8.7% and in a hospital was 15.4% of admissions, with the proportion of 69.2% discharged home and 5.6% discharged to a high-level care facility. During the study period, the proportion of ICU admissions with AECOPD per 10,000 admissions decreased at an annual rate of 2.0 (95% confidence interval [CI], 0.8-3.2; P = 0.009) but their admission rate per million population increased annually by 4.5 (95% CI, 3.7-5.3; P < 0.0001). There was a linear reduction in mortality for AECOPD but not for asthma admissions (odds ratio annual decline: AECOPD, 0.94 [0.93-0.95] and asthma, 1.01 [0.97-1.05]; P = 0.001) and an increase in AECOPD admissions discharged to home (odds ratio annual increase, AECOPD, 1.04 [1.03-1.05] and asthma, 1.01 [0.99-1.03]; P = 0.01). The reduction in mortality was sustained after adjusting for illness severity.Conclusions: Across Australia and New Zealand, the rate of ICU admissions due to AECOPD is increasing but mortality rates are decreasing, with a corresponding increase in the home discharge rates.
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Veno-Venous Extracorporeal Lung Support as a Bridge to or Through Lung Volume Reduction Surgery in Patients with Severe Hypercapnia. ASAIO J 2021; 66:952-959. [PMID: 32740358 DOI: 10.1097/mat.0000000000001108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Extracorporeal lung support (ECLS) represents an essential support tool especially for critically ill patients undergoing thoracic surgical procedures. Lung volume reduction surgery (LVRS) is an important treatment option for end-stage lung emphysema in carefully selected patients. Here, we report the efficacy of veno-venous ECLS (VV ECLS) as a bridge to or through LVRS in patients with end-stage lung emphysema and severe hypercapnia. Between January 2016 and May 2017, 125 patients with end-stage lung emphysema undergoing LVRS were prospectively enrolled into this study. Patients with severe hypercapnia caused by chronic respiratory failure were bridged to or through LVRS with low-flow VV ECLS (65 patients, group 1). Patients with preoperative normocapnia served as a control group (60 patients, group 2). In group 1, VV ECLS was implemented preoperatively in five patients and in 60 patients intraoperatively. Extracorporeal lung support was continued postoperatively in all 65 patients. Mean length of postoperative VV ECLS support was 3 ± 1 day. The 90 day mortality rate was 7.8% in group 1 compared with 5% in group 2 (p = 0.5). Postoperatively, a significant improvement was observed in quality of life, exercise capacity, and dyspnea symptoms in both groups. VV ECLS in patients with severe hypercapnia undergoing LVRS is an effective and well-tolerated treatment option. In particular, it increases the intraoperative safety, supports de-escalation of ventilatory strategies, and reduces the rate of postoperative complications in a cohort of patients considered "high risk" for LVRS in the current literature.
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10
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Fernando SM, McIsaac DI, Rochwerg B, Bagshaw SM, Muscedere J, Munshi L, Ferguson ND, Seely AJE, Cook DJ, Dave C, Tanuseputro P, Kyeremanteng K. Frailty and invasive mechanical ventilation: association with outcomes, extubation failure, and tracheostomy. Intensive Care Med 2019; 45:1742-1752. [PMID: 31595352 DOI: 10.1007/s00134-019-05795-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/22/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Invasive mechanical ventilation is a common form of life support provided to critically ill patients. Frailty is an emerging prognostic factor for poor outcome in the Intensive Care Unit (ICU); however, its association with adverse outcomes following invasive mechanical ventilation is unknown. We sought to evaluate the association between frailty, defined by the Clinical Frailty Scale (CFS), and outcomes of ICU patients receiving invasive mechanical ventilation. METHODS We performed a retrospective analysis (2011-2016) of a prospectively collected registry from two hospitals of consecutive ICU patients ≥ 18 years of age receiving invasive mechanical ventilation. CFS scores were based on recorded pre-admission function at the time of hospital admission. The primary outcome was hospital mortality. Secondary outcomes included discharge to long-term care, extubation failure at time of first liberation attempt, and tracheostomy. RESULTS We included 8110 patients, and 2529 (31.2%) had frailty (CFS ≥ 5). Frailty was associated with increased odds of hospital death (adjusted odds ratio [aOR]: 1.24 [95% confidence interval [CI] 1.10-1.40) and discharge to long-term care (aOR 1.21 [95% CI 1.13-1.35]). As compared to patients without frailty, patients with frailty had increased odds of extubation failure (aOR 1.17 [95% CI 1.04-1.37]), hospital death following extubation failure (aOR 1.18 [95% CI 1.07-1.28]), tracheostomy (aOR 1.17 [95% CI 1.01-1.36]), and hospital death following tracheostomy (aOR 1.14 [95% CI 1.03-1.25]). CONCLUSIONS The presence of frailty among patients receiving mechanical ventilation is associated with increased odds of hospital mortality, discharge to long-term care, extubation failure, and need for tracheostomy.
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Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. .,Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Bram Rochwerg
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - John Muscedere
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Niall D Ferguson
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Andrew J E Seely
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Deborah J Cook
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Chintan Dave
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Peter Tanuseputro
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Bruyere Research Institute, Ottawa, ON, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Institut du Savoir Montfort, Ottawa, ON, Canada
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11
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Ibrahim AS, Aly MG, Abdel-Rahman KA, Mohamed MA, Mehany MM, Aziz EM. Semi-quantitative Cough Strength Score as a Predictor for Extubation Outcome in Traumatic Brain Injury: A Prospective Observational Study. Neurocrit Care 2019; 29:273-279. [PMID: 29644564 DOI: 10.1007/s12028-018-0539-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Between 25 and 40% of extubated patients with traumatic brain injury (TBI) in the intensive care unit at our hospital (Assiut University Hospital-Assiut-Egypt) require reintubation. This reflects the importance of developing better criteria for predicting successful extubation in TBI. We evaluated the accuracy of semi-quantitative cough strength score (SCSS) and Glasgow coma scale (GCS) in predicting extubation outcomes in TBI. METHODS This prospective observational study included patients (18-65 years), with TBI on mechanical ventilation more than 24 h who were ready to be weaned off. Three tools were used. Tool I: Patient assessment sheet, this tool used to assess socio-demographic and clinical data of patients. Tool II: Semi-quantitative cough strength score (0-5). Tool III: Factors affecting successful extubation, this tool used to confirm the presence or absence of factors that can interfere with the results of extubation outcomes. After extubation, patient was followed up for 72 h to check for extubation success. Multivariate logistic binary regression test was used to calculate odds ratio for different clinical data collected before extubation as independent factors and successful extubation as a dependent factor. RESULTS Among 80 patients of mean age 40.6 (± 16.1), 34% were female, median admission GCS was 8 (4-13), extubation occurred on mean post-injury day 6.5 (± 4), and 46.3% required reintubation. Successfully extubated patients had higher semi-quantitative cough scores and GCS. 81.3% patients with SCSS 5 were successfully extubated, while all patients with SCSS 0 were reintubated. All patients with GCS 15 were successfully extubated, and all patients with GCS < 12 required intubation. CONCLUSION SCSS has shown promise in predicting successful extubation in TBI.
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Affiliation(s)
- Abdelrady S Ibrahim
- Anaesthesia and ICU Department, Faculty of Medicine, Assiut University Hospital, Assiut City, 7111, Egypt.
| | - Mohamed G Aly
- Anaesthesia and ICU Department, Faculty of Medicine, Assiut University Hospital, Assiut City, 7111, Egypt
| | - Khaled A Abdel-Rahman
- Anaesthesia and ICU Department, Faculty of Medicine, Assiut University Hospital, Assiut City, 7111, Egypt
| | - Mona A Mohamed
- Critical Care and Emergency Nursing Department, Faculty of Nursing, Assiut University, Assiut, Egypt
| | - Mogedda M Mehany
- Critical Care and Emergency Nursing Department, Faculty of Nursing, Assiut University, Assiut, Egypt
| | - Eman M Aziz
- Critical Care and Emergency Nursing Department, Faculty of Nursing, Assiut University, Assiut, Egypt
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12
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Steriade AT, Johari S, Sargarovschi N, Necula D, Tudose CE, Ionita D, Bogdan MA, Bumbacea D. Predictors of outcome of noninvasive ventilation in severe COPD exacerbation. BMC Pulm Med 2019; 19:131. [PMID: 31319839 PMCID: PMC6639947 DOI: 10.1186/s12890-019-0892-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 07/09/2019] [Indexed: 12/24/2022] Open
Abstract
Background Noninvasive ventilation (NIV) reduces the rate of endotracheal intubation (ETI) and overall mortality in severe acute exacerbation of COPD (AECOPD) with acute respiratory failure and is increasingly applied in respiratory intermediate care units. However, inadequate patient selection and incorrect management of NIV increase mortality. We aimed to identify factors that predict the outcome of NIV in AECOPD. Also, we looked for factors that influence ventilator settings and duration. Methods A prospective cohort study was undertaken in a respiratory intermediate care unit in an academic medical center between 2016 and 2017. Age, BMI, lung function, arterial pH and pCO2 at admission (t0), at 1–2 h (t1) and 4–6 h (t2) after admission, creatinine clearance, echocardiographic data (that defined left heart dysfunction), mean inspiratory pressure during the first 72 h (mIPAP-72 h) and hours of NIV during the first 72 h (dNIV-72 h) were recorded. Main outcome was NIV failure (i.e., ETI or in-hospital death). Secondary outcomes were in-hospital mortality, length of stay (LOS), duration of NIV (days), mIPAP-72 h, and dNIV-72 h. Results We included 89 patients (45 male, mean age 67.6 years) with AECOPD that required NIV. NIV failure was 12.4%, and in-hospital mortality was 11.2%. NIV failure was correlated with days of NIV, LOS, in-hospital mortality (p < 0.01), and kidney dysfunction (p < 0.05). In-hospital mortality was strongly associated with days of NIV (OR 1.27, 95%CI: 1.07–1.5, p < 0.01) and with FEV1 (p < 0.05). All other investigated parameters (including left heart dysfunction, dNIV-72 h, mIPAP-72 h, pH, etc.) did not influence NIV failure or mortality. dNIV-72 h and days of NIV were independent predictors of LOS (p < 0.01). Regarding the secondary outcomes, left heart dysfunction and pH at 1-2 h independently predicted NIV duration (dNIV-72 h, p < 0.01), while BMI and baseline pCO2 predicted NIV settings (mIPAP-72 h, p < 0.01). Conclusion In-hospital mortality and NIV failure were not influenced by BMI, left heart dysfunction, age, nor by arterial blood gas values in the first 6 h of NIV. Patients with severe acidosis and left heart dysfunction required prolonged use of NIV. BMI and pCO2 levels influence the NIV settings in AECOPD regardless of lung function.
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Affiliation(s)
- Alexandru T Steriade
- Department of Pneumology & Acute Respiratory Care, "Elias" Emergency University Hospital, 17 Marasti Blvd, 011461, Bucharest, Romania. .,"Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474, Bucharest, Romania.
| | - Shirin Johari
- Department of Pneumology & Acute Respiratory Care, "Elias" Emergency University Hospital, 17 Marasti Blvd, 011461, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474, Bucharest, Romania
| | - Nicoleta Sargarovschi
- Department of Pneumology & Acute Respiratory Care, "Elias" Emergency University Hospital, 17 Marasti Blvd, 011461, Bucharest, Romania
| | - Daniela Necula
- Department of Pneumology & Acute Respiratory Care, "Elias" Emergency University Hospital, 17 Marasti Blvd, 011461, Bucharest, Romania
| | - Cornelia E Tudose
- Department of Pneumology & Acute Respiratory Care, "Elias" Emergency University Hospital, 17 Marasti Blvd, 011461, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474, Bucharest, Romania
| | - Diana Ionita
- Department of Pneumology & Acute Respiratory Care, "Elias" Emergency University Hospital, 17 Marasti Blvd, 011461, Bucharest, Romania
| | - Miron A Bogdan
- "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474, Bucharest, Romania.,"Marius Nasta" Institute of Pneumology, 90 Viilor St., București, 050152, Bucharest, Romania
| | - Dragos Bumbacea
- Department of Pneumology & Acute Respiratory Care, "Elias" Emergency University Hospital, 17 Marasti Blvd, 011461, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474, Bucharest, Romania
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13
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Jing G, Li J, Hao D, Wang T, Sun Y, Tian H, Fu Z, Zhang Y, Wang X. Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: A pilot randomized controlled trial. Res Nurs Health 2019; 42:217-225. [PMID: 30887549 DOI: 10.1002/nur.21942] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/11/2019] [Accepted: 02/22/2019] [Indexed: 12/27/2022]
Abstract
High flow nasal cannula (HFNC) has been shown to improve extubation outcomes in patients with hypoxemia, but the role of HFNC in weaning patients with chronic obstructive pulmonary disease (COPD) with hypercapnia from invasive ventilation is unclear. We compared the effects of HFNC to noninvasive ventilation (NIV) on postextubation vital signs and arterial blood gases (ABGs) among patients with COPD. Other outcomes included comfort scores, need for bronchoscopy, use of pulmonary medications, and chest physiotherapy. Forty-two COPD patients who had persistent hypercapnia at extubation were assigned randomly to receive HFNC (22) or NIV (20). Twenty patients in each group were enrolled for per-protocol analysis with regard to primary outcomes. Vital signs and ABGs before extubation were similar between groups. At 3 hr after extubation, pH in the NIV group was lower than HFNC group (7.42 ± 0.06 vs. 7.45 ± 0.05, p = 0.01). At 24 hr after extubation, patients' mean arterial pressure (82.97 ± 9.04 vs. 92.06 ± 11.11 mmHg, p = 0.05) and pH (7.42 ± 0.05 vs. 7.46 ± 0.03, p = 0.05) in the NIV group were lower than in the HFNC group. No significant differences were found at 48 hr after extubation. In the HFNC group, comfort scores were better (3.55 ± 2.01 vs. 5.15 ± 2.28, p = 0.02) and fewer patients needed bronchoscopy for secretion management within 48 hr after extubation (2/22 vs. 9/20, p = 0.03). HFNC is a potential alternative to NIV to wean hypercapnic COPD patients with regard to vital signs and ABGs, HFNC improved patients' comfort and secretion clearance.
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Affiliation(s)
- Guoqiang Jing
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, Illinois
| | - Dong Hao
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Tao Wang
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Yunliang Sun
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Huanhuan Tian
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Zhong Fu
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Yuewei Zhang
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Xiaozhi Wang
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
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Gadre SK, Duggal A, Mireles-Cabodevila E, Krishnan S, Wang XF, Zell K, Guzman J. Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive pulmonary disease (COPD). Medicine (Baltimore) 2018; 97:e0487. [PMID: 29703009 PMCID: PMC5944543 DOI: 10.1097/md.0000000000010487] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There are limited data on the epidemiology of acute respiratory failure necessitating mechanical ventilation in patients with severe chronic obstructive pulmonary disease (COPD). The prognosis of acute respiratory failure requiring invasive mechanical ventilation is believed to be grim in this population. The purpose of this study was to illustrate the epidemiologic characteristics and outcomes of patients with underlying severe COPD requiring mechanical ventilation.A retrospective study of patients admitted to a quaternary referral medical intensive care unit (ICU) between January 2008 and December 2012 with a diagnosis of severe COPD and requiring invasive mechanical ventilation for acute respiratory failure.We evaluated 670 patients with an established diagnosis of severe COPD requiring mechanical ventilation for acute respiratory failure of whom 47% were male with a mean age of 63.7 ± 12.4 years and Acute physiology and chronic health evaluation (APACHE) III score of 76.3 ± 27.2. Only seventy-nine (12%) were admitted with a COPD exacerbation, 27(4%) had acute respiratory distress syndrome (ARDS), 78 (12%) had pneumonia, 78 (12%) had sepsis, and 312 (47%) had other causes of respiratory failure, including pulmonary embolism, pneumothorax, etc. Eighteen percent of the patients received a trial of noninvasive positive pressure ventilation. The median duration of mechanical ventilation was 3 days (interquartile range IQR 2-7); the median duration for ICU length of stay (LOS) was 5 (IQR 2-9) days and the median duration of hospital LOS was 12 (IQR 7-22) days. The overall ICU mortality was 25%. Patients with COPD exacerbation had a shorter median duration of mechanical ventilation (2 vs 4 days; P = .04), ICU (3 vs 5 days; P = .01), and hospital stay (10 vs 13 days; P = .01). The ICU mortality (9% vs 27%; P < .001), and the hospital mortality (17% vs 32%; P = .004) for mechanically ventilated patients with an acute exacerbation of severe COPD were lower than those with other etiologies of acute respiratory failure. A 1-unit increase in the APACHE III score was associated with a 1% decrease and having an active cancer was associated with a 45% decrease in ICU survival (P < .001). A discharge home at the time of index admission was associated an increased overall survival compared with any other discharge location (P < .001).We report good early outcomes, but significant long-term morbidity in patients with severe COPD requiring invasive mechanical ventilation for acute respiratory failure. A higher APACHE score and presence of active malignancy are associated with a decrease in ICU survival, whereas a discharge home is associated with an increase in the overall survival.
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Affiliation(s)
- Shruti K. Gadre
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute
| | - Abhijit Duggal
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute
| | | | - Sudhir Krishnan
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute
| | - Xiao-Feng Wang
- Respiratory Institute Biostatistics Core, Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Katrina Zell
- Respiratory Institute Biostatistics Core, Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Jorge Guzman
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute
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15
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Brat K, Plutinsky M, Hejduk K, Svoboda M, Popelkova P, Zatloukal J, Volakova E, Fecaninova M, Heribanova L, Koblizek V. Respiratory parameters predict poor outcome in COPD patients, category GOLD 2017 B. Int J Chron Obstruct Pulmon Dis 2018; 13:1037-1052. [PMID: 29628761 PMCID: PMC5877495 DOI: 10.2147/copd.s147262] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Respiratory parameters are important predictors of prognosis in the COPD population. Global Initiative for Obstructive Lung Disease (GOLD) 2017 Update resulted in a vertical shift of patients across COPD categories, with category B being the most populous and clinically heterogeneous. The aim of our study was to investigate whether respiratory parameters might be associated with increased all-cause mortality within GOLD category B patients. Methods The data were extracted from the Czech Multicentre Research Database, a prospective, noninterventional multicenter study of COPD patients. Kaplan-Meier survival analyses were performed at different levels of respiratory parameters (partial pressure of oxygen in arterial blood [PaO2], partial pressure of arterial carbon dioxide [PaCO2] and greatest decrease of basal peripheral capillary oxygen saturation during 6-minute walking test [6-MWT]). Univariate analyses using the Cox proportional hazard model and multivariate analyses were used to identify risk factors for mortality in hypoxemic and hypercapnic individuals with COPD. Results All-cause mortality in the cohort at 3 years of prospective follow-up reached 18.4%. Chronic hypoxemia (PaO2 <7.3 kPa), hypercapnia (PaCO2 >7.0 kPa) and oxygen desaturation during the 6-MWT were predictors of long-term mortality in COPD patients with forced expiratory volume in 1 second ≤60% for the overall cohort and for GOLD B category patients. Univariate analyses confirmed the association among decreased oxemia (<7.3 kPa), increased capnemia (>7.0 kPa), oxygen desaturation during 6-MWT and mortality in the studied groups of COPD subjects. Multivariate analysis identified PaO2 <7.3 kPa as a strong independent risk factor for mortality. Conclusion Survival analyses showed significantly increased all-cause mortality in hypoxemic and hypercapnic GOLD B subjects. More important, PaO2 <7.3 kPa was the strongest risk factor, especially in category B patients. In contrast, the majority of the tested respiratory parameters did not show a difference in mortality in the GOLD category D cohort.
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Affiliation(s)
- Kristian Brat
- Department of Respiratory Diseases, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Marek Plutinsky
- Department of Respiratory Diseases, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Karel Hejduk
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Michal Svoboda
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | | | | | - Eva Volakova
- Pulmonary Department, University Hospital, Olomouc, Czech Republic
| | | | - Lucie Heribanova
- Department of Respiratory Medicine, Thomayer Hospital, Prague, Czech Republic
| | - Vladimir Koblizek
- Pulmonary Department, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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16
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Khatib KI, Dixit SB, Joshi MM. Factors determining outcomes in adult patient undergoing mechanical ventilation: A "real-world" retrospective study in an Indian Intensive Care Unit. Int J Crit Illn Inj Sci 2018; 8:9-16. [PMID: 29619334 PMCID: PMC5869804 DOI: 10.4103/ijciis.ijciis_41_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Characteristics of patients admitted to intensive care units with respiratory failure (RF) and undergoing mechanical ventilation (MV) have been described for particular indications and diseases, but there are few studies in the general Intensive Care Unit (ICU) population and even lesser from developing countries. Objective: This study aims to study clinical characteristics, outcomes, and factors affecting outcomes in adult patients with RF on MV admitted to ICU. Methods: A retrospective study of medical records of all patients admitted to ICU between January 1, 2015, and March 31, 2016. Patients receiving MV for more than 6 h were included in the study. Patients younger than 12 years were excluded. Data were recorded of all patients receiving MV during this period regarding demographics, indications for MV, type and characteristics of ventilation, concomitant complications and treatment, and outcomes. Data were recorded at the initiation of MV and daily all throughout the course of MV. The main outcome measure was all-cause mortality at the end of ICU stay. Results: Of the 500 patients admitted to the ICU during the period of the study, a total of 122 patients received MV (and were included in study) for mean (standard deviation [SD]) duration of 4 (3.4) days. The mean (SD) stay in ICU and hospital was 4.49 (3.52) and 6.4 (3.6), respectively. Overall mortality for the unselected general ICU patients on MV was 67.21% while that for ARDS patients was 76.1%. The main factors independently associated with increased mortality were (i) pre-MV factors: age, Apache II scores, heart failure (odds ratio [OR], 1.42; 95% confidence interval [CI], 0.54–3.73; P < 0.001); (ii) patient management factors: positive end-expiratory pressure (OR, 2.69; 95% CI, 0.84–8.61; P < 0.001); (iii) Factors occurring over the course of MV: PaO2/FiO2 ratio < 100 (OR, 1.66; 95% CI, 0.67–4.11; P < 0.001) and development of renal failure (OR, 2.33; 95% CI, 2.05–2.42; P < 0.001) and hepatic failure (OR, 2.07; 95% CI, 1.91–2.24; P < 0.001) after initiation of MV. Conclusions: Outcomes of patients undergoing MV are dependent on various factors (including patient demographics, nature of associated morbidity, characteristics of the MV received, and conditions developing over course of MV) and these factors may be present before or develop after initiation of MV.
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Affiliation(s)
- Khalid Ismail Khatib
- Department of Medicine, SKN Medical College, Pune, Maharashtra, India.,Intensive Care Unit, MJM Hospital, Pune, Maharashtra, India
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17
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Brown H, Dodic S, Goh SS, Green C, Wang WC, Kaul S, Tiruvoipati R. Factors associated with hospital mortality in critically ill patients with exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:2361-2366. [PMID: 30122916 PMCID: PMC6080864 DOI: 10.2147/copd.s168983] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION COPD is a leading cause of morbidity and mortality worldwide. Patients with COPD often require admission to intensive care units (ICU) during an acute exacerbation. OBJECTIVE This study aimed to identify the factors independently associated with hospital mortality in patients requiring ICU admission for acute exacerbation of COPD. METHODS Patients admitted to the ICU of Frankston Hospital between January 2005 and June 2016 with an admission diagnosis of COPD were retrospectively identified from ICU databases. Patients' comorbidities, arterial blood gas results, and in-patient interventions were retrieved from their medical records. Outcomes analyzed included hospital and ICU length of stay (LOS) and mortality. RESULTS A total of 305 patients were included. Mean age was 67.4 years. A total of 77% of patients required non-invasive ventilation; and 38.7% required invasive mechanical ventilation (IMV) for a median of 127.2 hours (SD =179.5). Mean ICU LOS was 4.5 days (SD =5.96), and hospital LOS was 11.6 days (SD =13). In-hospital mortality was 18.7%. Multivariate analysis revealed that patient age (odds ratio [OR] =1.06; 95% CI: 1.031-1.096), ICU LOS (OR =1.26; 95% CI: 1.017-1.571), Acute Physiology and Chronic Health Evaluation-II score (OR =1.07; 95% CI: 1.012-1.123), and requirement for IMV (OR =4.09; 95% CI: 1.791-9.324) to be significantly associated with in-hospital mortality. CONCLUSION Patient age, requirement for IMV, and illness severity were associated with poor patient outcomes.
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Affiliation(s)
- Hamish Brown
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, VIC, Australia,
| | - Stefan Dodic
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, VIC, Australia,
| | - Sheen Sern Goh
- Department of Medicine, Frankston Hospital, Melbourne, VIC, Australia
| | - Cameron Green
- Department of Intensive Care Medicine, Frankston Hospital, Melbourne, VIC, Australia,
| | - Wei C Wang
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, VIC, Australia,
| | - Sameer Kaul
- Department of Respiratory Medicine, Frankston Hospital, Melbourne, VIC, Australia
| | - Ravindranath Tiruvoipati
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, VIC, Australia,
- Department of Intensive Care Medicine, Frankston Hospital, Melbourne, VIC, Australia,
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18
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[Management of inpatients with acute COPD exacerbation. When to indicate mechanical ventilation?]. Rev Mal Respir 2017; 34:439-449. [PMID: 28502366 DOI: 10.1016/j.rmr.2017.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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19
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Adrish M, Nannaka VB, Cano EJ, Bajantri B, Diaz-Fuentes G. Significance of NT-pro-BNP in acute exacerbation of COPD patients without underlying left ventricular dysfunction. Int J Chron Obstruct Pulmon Dis 2017; 12:1183-1189. [PMID: 28458528 PMCID: PMC5402900 DOI: 10.2147/copd.s134953] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND B-type natriuretic peptide (BNP) and the N-terminal fragment of pro-BNP (NT-pro-BNP) are established biomarkers of heart failure. Increased levels of natriuretic peptide (NP) have been associated with poor outcomes in acute exacerbation of COPD (AECOPD); however, most studies did not address the conditions that can also increase NT-pro-BNP levels. We aimed to determine if NT-pro-BNP levels correlate with outcomes of AECOPD in patients without heart failure and other conditions that can affect NT-pro-BNP levels. METHODS We conducted a retrospective study in patients hospitalized for AECOPD with available NT-pro-BNP levels and normal left ventricular ejection fraction. We compared patients with normal and elevated NT-pro-BNP levels and analyzed the clinical and outcome data. RESULTS A total of 167 of 1,420 (11.7%) patients met the study criteria. A total of 77% of male patients and 53% of female patients had elevated NT-pro-BNP levels (P=0.0031). NT-pro-BNP levels were not associated with COPD severity and comorbid illnesses. Log-transformed NT-pro-BNP levels were positively associated with echocardiographically estimated right ventricular systolic pressure (r=0.3658; 95% confidence interval [CI]: 0.2060-0.5067; P<0.0001). Patients with elevated NT-pro-BNP levels were more likely to require intensive care (63% vs 43%; P=0.0207) and had a longer hospital length of stay (P=0.0052). There were no differences in the need for noninvasive positive pressure ventilation (P=0.1245) or mechanical ventilation (P=0.9824) or in regard to in-hospital mortality (P=0.5273). CONCLUSION Patients with AECOPD and elevated NT-pro-BNP levels had increased hospital length of stay and need for intensive care. Based on our study, serum NT-pro-BNP levels cannot be used as a biomarker for increased mortality or requirement for invasive or noninvasive ventilation in this group of patients.
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Affiliation(s)
- Muhammad Adrish
- Division of Pulmonary and Critical Care Medicine, Bronx-Lebanon Hospital Center, Icahn School of Medicine at Mount Sinai
| | - Varalaxmi Bhavani Nannaka
- Department of Critical Care Medicine, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine
| | - Edison J Cano
- Department of Medicine, Bronx-Lebanon Hospital Center, Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Bharat Bajantri
- Division of Pulmonary and Critical Care Medicine, Bronx-Lebanon Hospital Center, Icahn School of Medicine at Mount Sinai
| | - Gilda Diaz-Fuentes
- Division of Pulmonary and Critical Care Medicine, Bronx-Lebanon Hospital Center, Icahn School of Medicine at Mount Sinai
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20
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Dres M, Hausfater P, Foissac F, Bernard M, Joly LM, Sebbane M, Philippon AL, Gil-Jardiné C, Schmidt J, Maignan M, Treluyer JM, Roche N. Mid-regional pro-adrenomedullin and copeptin to predict short-term prognosis of COPD exacerbations: a multicenter prospective blinded study. Int J Chron Obstruct Pulmon Dis 2017; 12:1047-1056. [PMID: 28408815 PMCID: PMC5383071 DOI: 10.2147/copd.s126400] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Exacerbations of COPD (ECOPD) are a frequent cause of emergency room (ER) visits. Predictors of early outcome could help clinicians in orientation decisions. In the current study, we investigated whether mid-regional pro-adrenomedullin (MR-proADM) and copeptin, in addition to clinical evaluation, could predict short-term outcomes. PATIENTS AND METHODS This prospective blinded observational study was conducted in 20 French centers. Patients admitted to the ER for an ECOPD were considered for inclusion. A clinical risk score was calculated, and MR-proADM and copeptin levels were determined from a venous blood sample. The composite primary end point comprised 30-day death or transfer to the intensive care unit or a new ER visit. RESULTS A total of 379 patients were enrolled in the study, of whom 277 were eventually investigated for the primary end point that occurred in 66 (24%) patients. In those patients, the median (interquartile range [IQR]) MR-proADM level was 1.02 nmol/L (0.77-1.48) versus 0.83 nmol/L (0.63-1.07) in patients who did not meet the primary end point (P=0.0009). In contrast, copeptin levels were similar in patients who met or did not meet the primary end point (P=0.23). MR-proADM levels increased with increasing clinical risk score category: 0.74 nmol/L (0.57-0.89), 0.83 nmol/L (0.62-1.12) and 0.95 nmol/L (0.75-1.29) for the low-, intermediate- and high-risk categories, respectively (P<0.001). MR-proADM was independently associated with the primary end point (odds ratio, 1.65; 95% confidence interval [CI], 1.10-2.48; P=0.015). MR-proADM predicted the occurrence of primary end point with a sensitivity of 46% (95% CI, 33%-58%) and a specificity of 79% (95% CI, 74-84). CONCLUSION MR-proADM but not copeptin was significantly associated with outcomes at 30 days, even after adjustment for clinical risk category. Overall, MR-proADM, alone or combined with the clinical risk score, was a moderate strong predictor of short-term outcomes.
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Affiliation(s)
- Martin Dres
- Pulmonary and Critical Care Department, Pitié-Salpêtrière Hospital, AP-HP
- UMRS1158: Clinical and Experimental Respiratory Neurophysiology, Paris 6 University
| | - Pierre Hausfater
- Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP
- Sorbonne Universités UPMC Univ-Paris06, GRC-14 BIOSFAST
| | - Frantz Foissac
- Clinical Research Department, Necker Cochin Hospital, AP-HP
- EA 7323, Sorbonne Paris-Cité
| | - Maguy Bernard
- Biochemistry Department, Pitié-Salpêtrière Hospital, AP-HP, Paris
| | | | - Mustapha Sebbane
- Department of Emergency Medicine, Lapeyronie Hospital, Montpellier
| | - Anne-Laure Philippon
- Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP
- Sorbonne Universités UPMC Univ-Paris06, GRC-14 BIOSFAST
| | | | - Jeannot Schmidt
- Emergency Department, Gabriel Montpied Hospital, Clermont-Ferrand
| | - Maxime Maignan
- Emergency Department, Grenoble University Hospital, Grenoble
| | - Jean-Marc Treluyer
- Clinical Research Department, Paris Descartes University, Hôpital Cochin, AP-HP
| | - Nicolas Roche
- Pulmonary Department, Cochin Hospital, AP-HP
- Paris Descartes University, Paris, France
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Abstract
Invasive mechanical ventilation can successfully support the patient with acute respiratory failure, but it is associated with considerable risks. Numerous complications of invasive mechanical ventilation have been identified, and these may contribute to increased mortality. Therefore after clinical improvement has occurred, considerable emphasis is placed on expeditiously freeing the patient from the ventilator. This process of getting a patient off mechanical ventilation has been variably termed weaning, liberation, or discontinuation (terms which may be used interchangeably), and can be further divided into “readiness testing” and “progressive withdrawal.” Over the last decade, new developments in our understanding of the process of weaning have provided investigators with the tools to address a number of key questions: How should readiness for weaning (and trials of spontaneous breathing) be determined? What is the role of weaning parameters in deciding when to initiate the weaning process? What is the best mode for conducting a spontaneous breathing trial and how should the patient be monitored? What are the mechanisms for weaning (and spontaneous breathing trial) failure? What is the best technique to facilitate progressive withdrawal? What other factors can facilitate liberation from mechanical ventilation? What are the risks of extubation failure and how can extubation outcome best be predicted? What is the role for protocols in facilitating weaning from mechanical ventilation?.
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Affiliation(s)
- Scott K. Epstein
- Medical Intensive Care Unit, Pulmonary and Critical Care Division, New England Medical Center, and Tufts University School of Medicine, Boston, MA.
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Abstract
As many as 5% of patients who need mechanical ventilation will require prolonged mechanical ventilation (PMV). The cost of their care and its associated morbidity is alarming; however, good outcomes can be achieved when their care is specialized and delivered in a programmatic manner. In this article, we review some of the common and potentially reversible reasons why patients fail successfully liberation from mechanical ventilation. We examine the outcomes of patients requiring PMV and present evidence that supports the development of specialized units where patients can be cohorted and may produce better outcomes than would be likely if these patients remained in the ICU.
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Affiliation(s)
- P J Scalise
- Hospital for Special Care, New Britain, CT 06053, USA.
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Ergan B, Ergün R. Impact of anemia on short-term survival in severe COPD exacerbations: a cohort study. Int J Chron Obstruct Pulmon Dis 2016; 11:1775-83. [PMID: 27536089 PMCID: PMC4976907 DOI: 10.2147/copd.s111758] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Anemia is reported to be an independent predictor of hospitalizations and survival in COPD. However, little is known of its impact on short-term survival during severe COPD exacerbations. The primary objective of this study was to determine whether the presence of anemia increases the risk of death in acute respiratory failure due to severe COPD exacerbations. PATIENTS AND METHODS Consecutive patients with COPD exacerbation who were admitted to the intensive care unit with the diagnosis of acute respiratory failure and required either invasive or noninvasive ventilation (NIV) were analyzed. RESULTS A total of 106 patients (78.3% male; median age 71 years) were included in the study; of them 22 (20.8%) needed invasive ventilation immediately and 84 (79.2%) were treated with NIV. NIV failure was observed in 38 patients. Anemia was present in 50% of patients, and 39 patients (36.8%) died during hospital stay. When compared to nonanemic patients, hospital mortality was significantly higher in the anemic group (20.8% vs 52.8%, respectively; P=0.001). Stepwise multivariate logistic regression analysis showed that presence of anemia and NIV failure were independent predictors of hospital mortality with odds ratios (95% confidence interval) of 3.99 ([1.39-11.40]; P=0.010) and 2.56 ([1.60-4.09]; P<0.001), respectively. Anemia was not associated with long-term survival in this cohort. CONCLUSION Anemia may be a risk factor for hospital death in severe COPD exacerbations requiring mechanical ventilatory support.
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Affiliation(s)
- Begum Ergan
- Department of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Recai Ergün
- Medical Intensive Care Unit, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
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Yousif M, El Wahsh RA. Predicting in-hospital mortality in acute exacerbation of COPD: Is there a golden score? EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2016.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Toft-Petersen AP, Torp-Pedersen C, Weinreich UM, Rasmussen BS. Assisted ventilation in COPD - association between previous hospitalizations and mortality. Int J Chron Obstruct Pulmon Dis 2016; 11:935-43. [PMID: 27217743 PMCID: PMC4860999 DOI: 10.2147/copd.s97830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In general, previous studies have shown an association between prior exacerbations and mortality in COPD, but this association has not been demonstrated in the subpopulation of patients in need of assisted ventilation. We examined whether previous hospitalizations were independently associated with mortality among patients with COPD ventilated for the first time. PATIENTS AND METHODS In the Danish National Patient Registry, we established a cohort of patients with COPD ventilated for the first time from 2003 to 2011 and previously medicated for obstructive airway diseases. We assessed the number of hospitalizations for COPD in the preceding year, age, sex, comorbidity, mode of ventilation, survival to discharge, and days to death beyond discharge. RESULTS The cohort consisted of 6,656 patients of whom 66% had not been hospitalized for COPD in the previous year, 18% once, 8% twice, and 9% thrice or more. In-hospital mortality was 45%, and of the patients alive at discharge, 11% died within a month and 39% within a year. In multivariate models, adjusted for age, sex, mode of ventilation, and comorbidity, odds ratios for in-hospital death were 1.26 (95% confidence interval [CI]: 1.11-1.44), 1.43 (95% CI: 1.19-1.72), and 1.56 (95% CI: 1.30-1.87) with one, two, and three or more hospitalizations, respectively. Hazard ratios for death after discharge from hospital were 1.32 (95% CI: 1.19-1.46), 1.76 (95% CI: 1.52-2.02), and 2.07 (95% CI: 1.80-2.38) with one, two, and three or more hospitalizations, respectively. CONCLUSION Preceding hospitalizations for COPD are associated with in-hospital mortality and after discharge in the subpopulation of patients with COPD with acute exacerbation treated with assisted ventilation for the first time.
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Affiliation(s)
- Anne Pernille Toft-Petersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ulla Møller Weinreich
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Respiratory Medicine, Aalborg University Hospital, Denmark
| | - Bodil Steen Rasmussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
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Ocal S, Ortac Ersoy E, Ozturk O, Hayran M, Topeli A, Coplu L. Long-term outcome of chronic obstructive pulmonary disease patients with acute respiratory failure following intensive care unit discharge in Turkey. CLINICAL RESPIRATORY JOURNAL 2016; 11:975-982. [PMID: 26780291 DOI: 10.1111/crj.12450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 12/28/2015] [Accepted: 01/04/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) remains a globally significant cause of mortality, although COPD mortality varies from country to country, and across different regions within each country. The primary objective of this study was to determine the mortality rates of COPD patients who present with acute respiratory failure (ARF) to a tertiary care referral center in different stages of their follow-up (ICU, in-hospital and after discharge). The secondary objective was to determine factors associated with mortality in this group of patients. RESULTS Medical records of consecutive COPD patients over a 10-year period were reviewed.The study included 147 patients. Of these, 72 were treated initially with noninvasive positive pressure ventilation (NIPPV), and 12 of these required intubation after NIPPV failed. Therefore, 86 patients were intubated for invasive mechanical ventilation (IMV), while NIPPV was succesful in 60 patients. Survival time was independently associated with advanced age, high APACHE II score, co-morbidity and the need for IMV. The cumulative mortality was 27% in the medical ICU and 31% in hospital following ICU discharge. The mortality rate at 1, 2 and 5 years was 54%, 66% and 84%, respectively. CONCLUSION COPD patients admitted to the ICU for ARF have an approximately 70% chance of leaving hospital alive, but half of these may die in the first 6 months after discharge. The risk factors related to mortality were advanced age, high APACHE II score, co-morbidity and IMV requirement.
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Affiliation(s)
- Serpil Ocal
- Hacettepe University, Faculty of Medicine, Medical Intensive Care Unit, Ankara, Turkey
| | - Ebru Ortac Ersoy
- Hacettepe University, Faculty of Medicine, Medical Intensive Care Unit, Ankara, Turkey
| | - Ozge Ozturk
- Hacettepe University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
| | - Mutlu Hayran
- Hacettepe University, Faculty of Medicine, Department of Preventive Oncology, Ankara, Turkey
| | - Arzu Topeli
- Hacettepe University, Faculty of Medicine, Medical Intensive Care Unit, Ankara, Turkey
| | - Lutfi Coplu
- Hacettepe University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
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Agmy GR, Mohammad HA, Hassanin AAM. The prognostic value of the dead-space fraction and other physiological parameters in the weaning process of mechanical ventilation in patients with obstructive air flow. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2015. [DOI: 10.4103/1687-8426.165902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Alsubaiei ME, Cafarella PA, Frith PA, McEvoy RD, Effing TW. Current care services provided for patients with COPD in the Eastern province in Saudi Arabia: a descriptive study. Int J Chron Obstruct Pulmon Dis 2015; 10:2379-91. [PMID: 26604736 PMCID: PMC4639520 DOI: 10.2147/copd.s89456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND COPD is a leading cause of morbidity and mortality worldwide. The prevalence rate of COPD in the general Saudi population is estimated to be 2.4% and 14.2% among smokers. Not much is known about current health care services for patients with COPD in Saudi Arabia. The objective of this study was to determine the current care services for patients with COPD provided by government hospitals in the Eastern province of Saudi Arabia. METHODS A cross-sectional study was conducted in the Eastern province of Saudi Arabia. Directors of the Department of Internal Medicine from all 22 general government hospitals that are under the responsibility of the Ministry of Health or the Ministry of Higher Education in this region were asked to participate. Data were collected using a questionnaire. RESULTS The study results indicated that there are limited hospital facilities for patients with COPD: no respiratory departments in any of the included hospitals, no spirometry in 77.3% of the hospitals, no intensive care units in 63.7% of the hospitals, and no pulmonary rehabilitation program in any of the hospitals. Among the included 22 hospitals, 24 respiratory physicians, 29 respiratory therapists, and three physiotherapists were involved in COPD care. CONCLUSION In conclusion, current care services provided by government hospitals in the Eastern province of Saudi Arabia for patients with COPD do not meet international recommendations for COPD management. Increased awareness, knowledge, and implementation of COPD guidelines by health care providers will most probably improve COPD management in Saudi Arabia. In addition, the government could improve dissemination of information about COPD management through national programs and by offering specific education regarding respiratory diseases.
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Affiliation(s)
- Mohammed E Alsubaiei
- Repatriation General Hospital, Department of Respiratory Medicine, Adelaide, SA, Australia
- Flinders University, School of Medicine, Adelaide, SA, Australia
| | - Paul A Cafarella
- Repatriation General Hospital, Department of Respiratory Medicine, Adelaide, SA, Australia
- Flinders University, School of Medicine, Adelaide, SA, Australia
| | - Peter A Frith
- Repatriation General Hospital, Department of Respiratory Medicine, Adelaide, SA, Australia
- Flinders University, School of Medicine, Adelaide, SA, Australia
| | - R Doug McEvoy
- Flinders University, School of Medicine, Adelaide, SA, Australia
- Repatriation General Hospital, Sleep and Respiratory Medicine, Southern Adelaide Local Health Network, Daw Park, SA, Australia
| | - Tanja W Effing
- Repatriation General Hospital, Department of Respiratory Medicine, Adelaide, SA, Australia
- Flinders University, School of Medicine, Adelaide, SA, Australia
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Braune S, Burchardi H, Engel M, Nierhaus A, Ebelt H, Metschke M, Rosseau S, Kluge S. The use of extracorporeal carbon dioxide removal to avoid intubation in patients failing non-invasive ventilation--a cost analysis. BMC Anesthesiol 2015; 15:160. [PMID: 26537233 PMCID: PMC4634813 DOI: 10.1186/s12871-015-0139-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 10/22/2015] [Indexed: 11/17/2022] Open
Abstract
Background To evaluate the economic implications of the pre-emptive use of extracorporeal carbon dioxide removal (ECCO2R) to avoid invasive mechanical ventilation (IMV) in patients with hypercapnic ventilatory insufficiency failing non-invasive ventilation (NIV). Methods Retrospective ancillary cost analysis of data extracted from a recently published multicentre case–control-study (n = 42) on the use of arterio-venous ECCO2R to avoid IMV in patients with acute on chronic ventilatory failure. Cost calculations were based on average daily treatment costs for intensive care unit (ICU) and normal medical wards as well as on the specific costs of the ECCO2R system. Results In the group treated with ECCO2R IMV was avoided in 90 % of cases and mean hospital length of stay (LOS) was shorter than in the matched control group treated with IMV (23.0 vs. 42.0 days). The overall average hospital treatment costs did not differ between the two groups (41.134 vs. 39.366 €, p = 0.8). A subgroup analysis of patients with chronic obstructive pulmonary disease (COPD) revealed significantly lower median ICU length of stay (11.0 vs. 35.0 days), hospital length of stay (17.5 vs. 51.5 days) and treatment costs for the ECCO2R group (19.610 vs. 46.552 €, p = 0.01). Conclusions Additional costs for the use of arterio-venous ECCO2R to avoid IMV in patients with acute-on-chronic ventilatory insufficiency failing NIV may be offset by a cost reducing effect of a shorter length of ICU and hospital stay.
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Affiliation(s)
- Stephan Braune
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | | | - Markus Engel
- Department of Cardiology and Intensive Care, Klinikum Bogenhausen, Munich, Germany.
| | - Axel Nierhaus
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Henning Ebelt
- Department of Medicine III, University of Halle (Saale), Halle, Germany.
| | - Maria Metschke
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Simone Rosseau
- Department of Internal Medicine, Infectious Diseases and Respiratory Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Howe KP, Clochesy JM, Goldstein LS, Owen H. Mechanical Ventilation Antioxidant Trial. Am J Crit Care 2015; 24:440-5. [PMID: 26330437 DOI: 10.4037/ajcc2015335] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Many patients each year require prolonged mechanical ventilation. Inflammatory processes may prevent successful weaning, and evidence indicates that mechanical ventilation induces oxidative stress in the diaphragm, resulting in atrophy and contractile dysfunction of diaphragmatic myofibers. Antioxidant supplementation might mitigate the harmful effects of the oxidative stress induced by mechanical ventilation. OBJECTIVE To test the clinical effectiveness of antioxidant supplementation in reducing the duration of mechanical ventilation. METHODS A randomized, prospective, placebo-controlled double-blind design was used to test whether enterally administered antioxidant supplementation would decrease the duration of mechanical ventilation, all-cause mortality, and length of stay in the intensive care unit and hospital. Patients received vitamin C 1000 mg plus vitamin E 1000 IU, vitamin C 1000 mg plus vitamin E 1000 IU plus N-acetylcysteine 400 mg, or placebo solution as a bolus injection via their enteral feeding tube every 8 hours. RESULTS Clinical and statistically significant differences in duration of mechanical ventilation were seen among the 3 groups (Mantel-Cox log rank statistic = 5.69, df = 1, P = .017). The 3 groups did not differ significantly in all-cause mortality during hospitalization or in the length of stay in the intensive care unit or hospital. CONCLUSIONS Enteral administration of antioxidants is a simple, safe, inexpensive, and effective intervention that decreases the duration of mechanical ventilation in critically ill adults.
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Affiliation(s)
- Kimberly P. Howe
- Kimberly P. Howe is corporate director of academic affairs, Northside Medical Center, Youngstown, Ohio. John M. Clochesy is a professor, University of South Florida College of Nursing, Tampa, Florida. Lawrence S. Goldstein is medical director of the medical intensive care unit, Northside Medical Center, and an associate professor at Northeastern Ohio Universities College of Medicine, Rootstown, Ohio. Hugh Owen is a pharmacist at Northside Medical Center
| | - John M. Clochesy
- Kimberly P. Howe is corporate director of academic affairs, Northside Medical Center, Youngstown, Ohio. John M. Clochesy is a professor, University of South Florida College of Nursing, Tampa, Florida. Lawrence S. Goldstein is medical director of the medical intensive care unit, Northside Medical Center, and an associate professor at Northeastern Ohio Universities College of Medicine, Rootstown, Ohio. Hugh Owen is a pharmacist at Northside Medical Center
| | - Lawrence S. Goldstein
- Kimberly P. Howe is corporate director of academic affairs, Northside Medical Center, Youngstown, Ohio. John M. Clochesy is a professor, University of South Florida College of Nursing, Tampa, Florida. Lawrence S. Goldstein is medical director of the medical intensive care unit, Northside Medical Center, and an associate professor at Northeastern Ohio Universities College of Medicine, Rootstown, Ohio. Hugh Owen is a pharmacist at Northside Medical Center
| | - Hugh Owen
- Kimberly P. Howe is corporate director of academic affairs, Northside Medical Center, Youngstown, Ohio. John M. Clochesy is a professor, University of South Florida College of Nursing, Tampa, Florida. Lawrence S. Goldstein is medical director of the medical intensive care unit, Northside Medical Center, and an associate professor at Northeastern Ohio Universities College of Medicine, Rootstown, Ohio. Hugh Owen is a pharmacist at Northside Medical Center
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Planquette B, Péron J, Dubuisson E, Roujansky A, Laurent V, Le Monnier A, Legriel S, Ferre A, Bruneel F, Chiles PG, Bedos JP. Antibiotics against Pseudomonas aeruginosa for COPD exacerbation in ICU: a 10-year retrospective study. Int J Chron Obstruct Pulmon Dis 2015; 10:379-88. [PMID: 25733827 PMCID: PMC4337514 DOI: 10.2147/copd.s71413] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
SUMMARY Chronic obstructive pulmonary disease (COPD) is a frequent source of hospitalization. Antibiotics are largely prescribed during COPD exacerbation. Our hypothesis is that large broad-spectrum antibiotics are more and more frequently prescribed. Our results confirm this trend and highlight that the increase in large broad-spectrum use in COPD exacerbation is largely unexplained. BACKGROUND Acute COPD exacerbation (AECOPD) is frequently due to respiratory tract infection, and the benefit of antipseudomonal antibiotics (APA) is still debated. Health care-associated pneumonia (HCAP) was defined in 2005 and requires broad-spectrum antibiotherapy. The main objectives are to describe the antibiotic use for AECOPD in intensive care unit and to identify factors associated with APA use and AECOPD prognosis. METHODS We conducted a monocentric, retrospective study on all AECOPDs in the intensive care unit treated by antibiotics for respiratory tract infection. Treatment failure (TF) was defined by death, secondary need for mechanical ventilation, or secondary systemic steroid treatment. A multivariate analysis was used to assess factors associated with APA prescription and TF. RESULTS From January 2000 to December 2011, 111 patients were included. Mean age was 69 years (±12), mean forced expiratory volume 38% of theoretic value (±13). Thirty-five (31%) patients were intubated, and 52 (47%) were treated with noninvasive ventilation. From 107 patients, 8 (7%) cases of Pseudomonas aeruginosa were documented. APAs were prescribed in 21% of patients before 2006 versus 57% after (P=0.001). TF prevalence was 31%. Risk factors for P. aeruginosa in COPD and HCAP diagnosis did not influence APA, whereas the post-2006 period was independently associated with APA prescription (odds ratio 6.2; 95% confidence interval 1.9-20.3; P=0.0013). APA did not improve TF (odds ratio 1.09; 95% confidence interval 0.37-3.2). CONCLUSION HCAP guidelines were followed by an increase in APA use in AECOPD, without an improvement in prognosis. HCAP prevalence cannot account for the increasing APA trend. Time effect reveals a drift in practices. The microbiological effect of such a drift must be evaluated.
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Affiliation(s)
- Benjamin Planquette
- Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France ; Unité de Biostatistique Médicale, Hôpital Lyon Sud, Lyon, France ; Service de Microbiologie, Centre Hospitalier de Versailles, Le Chesnay, France ; Service de Pneumologie et de Soins Intensifs, Hôpital Européen Georges Pompidou, Université Paris René Descartes, Paris, France
| | - Julien Péron
- Unité de Biostatistique Médicale, Hôpital Lyon Sud, Lyon, France
| | - Etienne Dubuisson
- Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Ariane Roujansky
- Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Virginie Laurent
- Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Alban Le Monnier
- Service de Microbiologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Stephane Legriel
- Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Alexis Ferre
- Service de Pneumologie et de Soins Intensifs, Hôpital Européen Georges Pompidou, Université Paris René Descartes, Paris, France
| | - Fabrice Bruneel
- Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Peter G Chiles
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Jean P Bedos
- Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France
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Value of the DECAF score in predicting hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease admitted to Zagazig University Hospitals, Egypt. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hajizadeh N, Crothers K, Braithwaite RS. Using modeling to inform patient-centered care choices at the end of life. J Comp Eff Res 2014; 2:497-508. [PMID: 24236746 DOI: 10.2217/cer.13.53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Advance directives are often under-informed due to a lack of disease-specific prognostic information. Without well-informed advance directives patients may receive default care that is incongruent with their preferences. We aimed to further inform advance care planning in patients with severe chronic obstructive pulmonary disease by estimating outcomes with alternative advance directives. METHODS We designed a Markov microsimulation model estimating outcomes for patients choosing between the Full Code advance directive (permitting invasive mechanical ventilation), and the Do Not Intubate directive (only permitting noninvasive ventilation). RESULTS Our model estimates Full Code patients have marginally increased one-year survival after admission for severe respiratory failure, but are more likely to be residing in a nursing home and have frequent rehospitalizations for respiratory failure. CONCLUSION Patients with severe chronic obstructive pulmonary disease may consider these potential tradeoffs between survival, rehospitalizations and institutionalization when making informed advance care plans and end-of-life decisions. We highlight outcomes research needs for variables most influential to the model's outcomes, including the risk of complications of invasive mechanical ventilation and failing noninvasive mechanical ventilation.
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Affiliation(s)
- Negin Hajizadeh
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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Khalil MM, Abd Elfattah NM, El-Qusy AS. Assessment of the outcome of mechanically ventilated chronic obstructive pulmonary disease patients admitted in the respiratory ICU in Ain Shams University Hospital. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2014. [DOI: 10.4103/1687-8426.145708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Del Vecchio AM, Branigan PJ, Barnathan ES, Flavin SK, Silkoff PE, Turner RB. Utility of animal and in vivo experimental infection of humans with rhinoviruses in the development of therapeutic agents for viral exacerbations of asthma and chronic obstructive pulmonary disease. Pulm Pharmacol Ther 2014; 30:32-43. [PMID: 25445932 PMCID: PMC7110859 DOI: 10.1016/j.pupt.2014.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/24/2014] [Accepted: 10/29/2014] [Indexed: 12/16/2022]
Abstract
There is an association with acute viral infection of the respiratory tract and exacerbations of asthma and chronic obstructive pulmonary disease (COPD). Although these exacerbations are associated with several types of viruses, human rhinoviruses (HRVs) are associated with the vast majority of disease exacerbations. Due to the lack of an animal species that is naturally permissive for HRVs to use as a facile model system, and the limitations associated with animal models of asthma and COPD, studies of controlled experimental infection of humans with HRVs have been used and conducted safely for decades. This review discusses how these experimental infection studies with HRVs have provided a means of understanding the pathophysiology underlying virus-induced exacerbations of asthma and COPD with the goal of developing agents for their prevention and treatment.
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Affiliation(s)
- Alfred M Del Vecchio
- Janssen Research and Development, Immunology Clinical Research and Development, Welsh and McKean Roads, Spring House, PA 19477, USA
| | - Patrick J Branigan
- Janssen Research and Development, Immunology Clinical Research and Development, Welsh and McKean Roads, Spring House, PA 19477, USA
| | - Elliot S Barnathan
- Janssen Research and Development, Immunology Clinical Research and Development, Welsh and McKean Roads, Spring House, PA 19477, USA
| | - Susan K Flavin
- Janssen Research and Development, Immunology Clinical Research and Development, Welsh and McKean Roads, Spring House, PA 19477, USA
| | - Philip E Silkoff
- Janssen Research and Development, Immunology Clinical Research and Development, Welsh and McKean Roads, Spring House, PA 19477, USA.
| | - Ronald B Turner
- University of Virginia, School of Medicine, Charlottesville, VA 22908, USA
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Helmy TA, Baess AI, Monsif DAA, Elnasharty AAA. Role of C-reactive protein and interleukin-6 in predicting the prognosis of ICU-admitted patients with acute exacerbation of COPD. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2014.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Impact of nitroglycerin infusion on weaning off hypertensive mechanically ventilated chronic obstructive pulmonary disease patients. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2014.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Palliative and end-of-life care, once the purview of oncologists and intensivists, has also become the responsibility of the emergency physician. As our population ages and medical technology enables increased longevity, it is essential that all medical professionals know how to help patients negotiate the balance between quantity and quality of life. Emergency physicians have the opportunity to educate patients and their loved ones on how to best accomplish their goals of care while also enhancing quality of life through treatment of symptoms. The emergency physician must be aware of the ethical and medico-legal parameters that govern decision making.
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Takir HB, Karakurt Z, Salturk C, Kargin F, Balci M, Yalcinsoy M, Ozmen İ, Yazicioglu OM, Gungor G, Burunsuzoğlu B, Adiguzel N. Reasons for ICU Demand and Long-term Follow-up of a Chronic Obstructive Pulmonary Disease Cohort. COPD 2014; 11:627-38. [DOI: 10.3109/15412555.2014.898041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Matamis D, Tsagourias M, Papathanasiou A, Sineffaki H, Lepida D, Galiatsou E, Nakos G. Targeting occult heart failure in intensive care unit patients with acute chronic obstructive pulmonary disease exacerbation: Effect on outcome and quality of life. J Crit Care 2014; 29:315.e7-14. [DOI: 10.1016/j.jcrc.2013.11.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 09/15/2013] [Accepted: 11/10/2013] [Indexed: 12/19/2022]
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Determinants of noninvasive ventilation outcomes during an episode of acute hypercapnic respiratory failure in chronic obstructive pulmonary disease: the effects of comorbidities and causes of respiratory failure. BIOMED RESEARCH INTERNATIONAL 2014; 2014:976783. [PMID: 24563868 PMCID: PMC3915711 DOI: 10.1155/2014/976783] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/27/2013] [Indexed: 12/31/2022]
Abstract
Objectives. To investigate the effect of the cause of acute respiratory failure and the role of comorbidities both acute and chronic on the outcome of COPD patients admitted to Respiratory Intensive Care Unit (RICU) with acute respiratory failure and treated with NIV. Design. Observational prospective study. Patients and Methods. 176 COPD patients consecutively admitted to our RICU over a period of 3 years and treated with NIV were evaluated. In all patients demographic, clinical, and functional parameters were recorded including the cause of acute respiratory failure, SAPS II score, Charlson comorbidity index, and further comorbidities not listed in the Charlson index. NIV success was defined as clinical improvement leading to discharge to regular ward, while exitus or need for endotracheal intubation was considered failure. Results. NIV outcome was successful in 134 patients while 42 underwent failure. Univariate analysis showed significantly higher SAP II score, Charlson index, prevalence of pneumonia, and lower serum albumin level in the failure group. Multivariate analysis confirmed a significant predictive value for pneumonia and albumin. Conclusions. The most important determinants of NIV outcome in COPD patients are the presence of pneumonia and the level of serum albumin as an indicator of the patient nutritional status.
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Heming N, Urien S, Fulda V, Meziani F, Gacouin A, Clavel M, Planquette B, Faisy C. Population pharmacodynamic modeling and simulation of the respiratory effect of acetazolamide in decompensated COPD patients. PLoS One 2014; 9:e86313. [PMID: 24466018 PMCID: PMC3895035 DOI: 10.1371/journal.pone.0086313] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 12/09/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) patients may develop metabolic alkalosis during weaning from mechanical ventilation. Acetazolamide is one of the treatments used to reverse metabolic alkalosis. METHODS 619 time-respiratory (minute ventilation, tidal volume and respiratory rate) and 207 time-PaCO2 observations were obtained from 68 invasively ventilated COPD patients. We modeled respiratory responses to acetazolamide in mechanically ventilated COPD patients and then simulated the effect of increased amounts of the drug. RESULTS The effect of acetazolamide on minute ventilation and PaCO2 levels was analyzed using a nonlinear mixed effect model. The effect of different ventilatory modes was assessed on the model. Only slightly increased minute ventilation without decreased PaCO2 levels were observed in response to 250 to 500 mg of acetazolamide administered twice daily. Simulations indicated that higher acetazolamide dosage (>1000 mg daily) was required to significantly increase minute ventilation (P<.001 vs pre-acetazolamide administration). Based on our model, 1000 mg per day of acetazolamide would increase minute ventilation by >0.75 L min(-1) in 60% of the population. The model also predicts that 45% of patients would have a decrease of PaCO2>5 mmHg with doses of 1000 mg per day. CONCLUSIONS Simulations suggest that COPD patients might benefit from the respiratory stimulant effect after the administration of higher doses of acetazolamide.
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Affiliation(s)
- Nicholas Heming
- Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique−Hôpitaux de Paris, Paris, France
- * E-mail:
| | - Saïk Urien
- CIC-01109 Cochin-Necker INSERM, Unité de Recherche Clinique, Hôpital Tarnier, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique−Hôpitaux de Paris, Paris, France
| | - Virginie Fulda
- Centre Régional de Pharmacovigilance, Hôpital Européen Georges Pompidou, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique−Hôpitaux de Paris, Paris, France
| | - Ferhat Meziani
- Service de Réanimation Médicale, Hôpital Civil, Strasbourg, France
| | - Arnaud Gacouin
- Service de Réanimation Médicale et Infectieuse, Hôpital Pontchaillou, Rennes, France
| | - Marc Clavel
- Service de Réanimation Polyvalente, CHU de Limoges, Limoges, France
| | - Benjamin Planquette
- Service de Réanimation Médico-Chirurgicale, Hôpital André Mignot, Le Chesnay, France
| | - Christophe Faisy
- Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique−Hôpitaux de Paris, Paris, France
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Ismaeil MF, El-Shahat HM, El-Gammal MS, Abbas AM. Unplanned versus planned extubation in respiratory intensive care unit, predictors of outcome. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2013.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease. Ann Am Thorac Soc 2013; 10:81-9. [PMID: 23607835 DOI: 10.1513/annalsats.201208-043oc] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE There is a need to identify clinically meaningful predictors of mortality following hospitalized COPD exacerbation. OBJECTIVES The aim of this study was to systematically review the literature to identify clinically important factors that predict mortality after hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD). METHODS Eligible studies considered adults admitted to hospital with COPD exacerbation. Two authors independently abstracted data. Odds ratios were then calculated by comparing the prevalence of each predictor in survivors versus nonsurvivors. For continuous variables, mean differences were pooled by the inverse of their variance, using a random effects model. MEASUREMENTS AND MAIN RESULTS There were 37 studies included (189,772 study subjects) with risk of death ranging from 3.6% for studies considering short-term mortality, 31.0% for long-term mortality (up to 2 yr after hospitalization), and 29.0% for studies that considered solely intensive care unit (ICU)-admitted study subjects. Twelve prognostic factors (age, male sex, low body mass index, cardiac failure, chronic renal failure, confusion, long-term oxygen therapy, lower limb edema, Global Initiative for Chronic Lung Disease criteria stage 4, cor pulmonale, acidemia, and elevated plasma troponin level) were significantly associated with increased short-term mortality. Nine prognostic factors (age, low body mass index, cardiac failure, diabetes mellitus, ischemic heart disease, malignancy, FEV1, long-term oxygen therapy, and PaO2 on admission) were significantly associated with long-term mortality. Three factors (age, low Glasgow Coma Scale score, and pH) were significantly associated with increased risk of mortality in ICU-admitted study subjects. CONCLUSION Different factors correlate with mortality from COPD exacerbation in the short term, long term, and after ICU admission. These parameters may be useful to develop tools for prediction of outcome in clinical practice.
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Farah R, Khamisy-farah R, Arraf Z, Jacobson L, Makhoul N. Hypophosphatemia as a prognostic value in acute exacerbation of COPD. THE CLINICAL RESPIRATORY JOURNAL 2013; 7:407-415. [DOI: 10.1111/crj.12027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Raymond Farah
- Department of Internal Medicine B; Ziv Medical Center; Safed Israel
- Faculty of Medicine in the Galilee; Bar Ilan University; Safed Israel
| | | | - Zaher Arraf
- Department of Internal Medicine B; Ziv Medical Center; Safed Israel
| | - Larisa Jacobson
- Respiratory Intensive Care Unit; Western Galilee Hospital; Nahariya Israel
| | - Nicola Makhoul
- Respiratory Intensive Care Unit; Western Galilee Hospital; Nahariya Israel
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Predictors of in-hospital mortality and need for invasive mechanical ventilation in elderly COPD patients presenting with acute hypercapnic respiratory failure. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kocks JWH, van den Berg JWK, Kerstjens HAM, Uil SM, Vonk JM, de Jong YP, Tsiligianni IG, van der Molen T. Day-to-day measurement of patient-reported outcomes in exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2013; 8:273-86. [PMID: 23766644 PMCID: PMC3678711 DOI: 10.2147/copd.s43992] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Exacerbations of chronic obstructive pulmonary disease (COPD) are a major burden to patients and to society. Little is known about the possible role of day-to-day patient-reported outcomes during an exacerbation. This study aims to describe the day-to-day course of patient-reported health status during exacerbations of COPD and to assess its value in predicting clinical outcomes. Methods Data from two randomized controlled COPD exacerbation trials (n = 210 and n = 45 patients) were used to describe both the feasibility of daily collection of and the day-to-day course of patient-reported outcomes during outpatient treatment or admission to hospital. In addition to clinical parameters, the BORG dyspnea score, the Clinical COPD Questionnaire (CCQ), and the St George’s Respiratory Questionnaire were used in Cox regression models to predict treatment failure, time to next exacerbation, and mortality in the hospital study. Results All patient-reported outcomes showed a distinct pattern of improvement. In the multivariate models, absence of improvement in CCQ symptom score and impaired lung function were independent predictors of treatment failure. Health status and gender predicted time to next exacerbation. Five-year mortality was predicted by age, forced expiratory flow in one second % predicted, smoking status, and CCQ score. In outpatient management of exacerbations, health status was found to be less impaired than in hospitalized patients, while the rate and pattern of recovery was remarkably similar. Conclusion Daily health status measurements were found to predict treatment failure, which could help decision-making for patients hospitalized due to an exacerbation of COPD.
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Affiliation(s)
- Jan Willem H Kocks
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Alaithan AM, Memon JI, Rehmani RS, Qureshi AA, Salam A. Chronic obstructive pulmonary disease: hospital and intensive care unit outcomes in the Kingdom of Saudi Arabia. Int J Chron Obstruct Pulmon Dis 2012; 7:819-23. [PMID: 23269866 PMCID: PMC3529632 DOI: 10.2147/copd.s37611] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background There is little data surrounding the survival of patients with chronic obstructive pulmonary disease (COPD) who are admitted to the critical care unit with exacerbation of symptoms. We conducted a study to measure the in-hospital and intensive care unit (ICU) outcomes of patients admitted with COPD exacerbation, and identified the related prognostic factors. Method We performed a retrospective cohort study of patients who were admitted to the adult ICU between January 2006 and July 2011 for COPD exacerbation in King Abdulaziz National Guard Hospital, Al-Hasa, Saudi Arabia. Results During the study period, a total of 119 patients were admitted to the ICU with acute respiratory failure attributed to COPD exacerbation. The mean age was 72 ± 13 years, and 44 (37%) were females. The main cause of respiratory failure was infection, which occurred in 102 (86%) patients. Thirty-nine (33%) of the admitted patients were mechanically ventilated, and the median duration was 2.6 (1–42) days. The median lengths of the ICU and hospital stays were 3 (1–40) and 9 (2–43) days, respectively. The ICU mortality was 6%, and hospital mortality was 11%. Low Glasgow Coma Scale on admission, intubation, duration of mechanical ventilation, current smoking, tracheostomy, cardiopulmonary arrest, and the development of acute renal failure were associated with higher hospital mortality. Conclusion Early ICU and hospital mortality is low for COPD patients who have been admitted to the ICU with exacerbation. Low Glasgow Coma Scale scores on admission, intubation, prolonged use of mechanical ventilation, and the development of acute renal failure were identified as risk factors associated with increased hospital mortality.
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Anemia and blood transfusions in critically ill patients. JOURNAL OF BLOOD TRANSFUSION 2012; 2012:629204. [PMID: 24066259 PMCID: PMC3771125 DOI: 10.1155/2012/629204] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 09/11/2012] [Accepted: 09/30/2012] [Indexed: 12/21/2022]
Abstract
Anemia is common in critically ill patients. As a consequence packed red blood cell (PRBC) transfusions are frequent in the critically ill. Over the past two decades a growing body of literature has emerged, linking PRBC transfusion to infections, immunosuppression, organ dysfunction, and a higher mortality rate. However, despite growing evidence that risk of PRBC transfusion outweighs its benefit, significant numbers of critically ill patients still receive PRBC transfusion during their intensive care unit (ICU) stay. In this paper, we summarize the current literature concerning the impact of anemia on outcomes in critically ill patients and the potential complications of PRBC transfusions.
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