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Akbaş T, Güneş H. Characteristics and outcomes of patients with chronic obstructive pulmonary disease admitted to the intensive care unit due to acute hypercapnic respiratory failure. Acute Crit Care 2023; 38:49-56. [PMID: 36935534 PMCID: PMC10030250 DOI: 10.4266/acc.2022.01011] [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: 08/02/2022] [Accepted: 12/07/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND The study aimed to describe the clinical course, outcomes, and prognostic factors of chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure. METHODS This retrospective study involved patients with acute hypercapnic respiratory failure due to COPD of any cause admitted to the intensive care unit (ICU) for non-invasive or invasive mechanical ventilation (IMV) support between December 2015 and February 2020. RESULTS One hundred patients were evaluated. The main causes of acute hypercapnic respiratory failure were bronchitis, pneumonia, and heart failure. The patients' mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 23.0±7.2, and their IMV rate was 43%. ICU, in-hospital, and 90-day mortality rates were 21%, 29%, and 39%, respectively. Non-survivors had more pneumonia, shock within the first 24 hours of admission, IMV, vasopressor use, and renal replacement therapy, along with higher APACHE II scores, lower admission albumin levels and PaO2/ FiO2 ratios, and longer ICU and hospital stays than survivors. Logistic regression analysis identified APACHE II score (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.017-1.317; P=0.026), admission PaO2/FiO2 ratio (OR, 0.989; 95% CI, 0.978-0.999; P=0.046), and vasopressor use (OR, 8.827; 95% CI, 1.650-47.215; P=0.011) as predictors of ICU mortality. APACHE II score (OR, 1.099; 95% CI, 1.021-1.182; P=0.011) and admission albumin level (OR, 0.169; 95% CI, 0.056-0.514; P=0.002) emerged as predictors of 90-day mortality. CONCLUSIONS APACHE II scores, the PaO2/FiO2 ratio, vasopressor use, and albumin levels are significant short-term mortality predictors in severely ill COPD patients with acute hypercapnic respiratory failure.
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Affiliation(s)
- Türkay Akbaş
- Division of Intensive Care, Department of Internal Medicine, School of Medicine, Düzce University, Düzce, Türkiye
| | - Harun Güneş
- Department of Emergency Medicine, School of Medicine, Balıkesir University, Balıkesir, Türkiye
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Viana RCTP, Pincelli MP, Pizzichini E, Silva AP, Manes J, Marconi TD, Steidle LJM. Chronic obstructive pulmonary disease exacerbation in the intensive care unit: clinical, functional and quality of life at discharge and 3 months of follow up. Rev Bras Ter Intensiva 2018; 29:47-54. [PMID: 28444072 PMCID: PMC5385985 DOI: 10.5935/0103-507x.20170008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/03/2017] [Indexed: 11/20/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the clinical/functional aspects and quality of life of chronic obstructive pulmonary disease patients who were discharged after an intensive care unit admission for acute respiratory failure. Methods: This prospective study included chronic obstructive pulmonary disease patients who were admitted to two intensive care units between December of 2010 and August of 2011 and evaluated over three visits after discharge. Thirty patients were included, and 20 patients completed the three-month follow up. Results: There was a significant improvement in the following: forced expiratory flow in one second (L) (1.1/1.4/1.4; p = 0.019), six-minute walk test (m) (- /232.8 /272.6; p = 0.04), BODE score (7.5/5.0/3.8; p = 0.001), cognition measured by the Mini Mental State Examination (21/23.5/23.5; p = 0.008) and quality of life measured by the total Saint George Respiratory Questionnaire score (63.3/56.8/51, p = 0.02). The mean difference in the total score was 12.3 (between visits 1 and three). Important clinical differences were observed for the symptom score (18.8), activities score (5.2) and impact score (14.3). The majority of participants (80%) reported they would be willing to undergo a new intensive care unit admission. Conclusion: Despite the disease severity, there was a significant clinical, functional and quality of life improvement at the end of the third month. Most patients would be willing to undergo a new intensive care unit admission.
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Affiliation(s)
- Renata Cristina Teixeira Pinto Viana
- Clínica Médica, Universidade do Vale do Itajaí - Itajaí (SC), Brasil.,Terapia Intensiva e Cuidados Paliativos, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Mariangela Pimentel Pincelli
- Departamento de Clínica Médica/Pneumologia, Hospital Universitário, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil.,Terapia Intensiva, Hospital Nereu Ramos - Florianópolis (SC), Brasil
| | - Emílio Pizzichini
- Departamento de Clínica Médica/Pneumologia, Hospital Universitário, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | | | - Joice Manes
- Clínica Médica, Hospital Universitário, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | | | - Leila John Marques Steidle
- Departamento de Clínica Médica/Pneumologia, Hospital Universitário, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
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Duarte PA, Costa JB, Duarte ST, Taba S, Lordani CRF, Osaku EF, Costa CRLM, Miglioranza DC, Gund DP, Jorge AC. Characteristics and Outcomes of Intensive Care Unit Survivors: Experience of a Multidisciplinary Outpatient Clinic in a Teaching Hospital. Clinics (Sao Paulo) 2017; 72:764-772. [PMID: 29319723 PMCID: PMC5738566 DOI: 10.6061/clinics/2017(12)08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/16/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To describe the experience of an outpatient clinic with the multidisciplinary evaluation of intensive care unit survivors and to analyze their social, psychological, and physical characteristics in a low-income population and a developing country. METHODS Retrospective cohort study. Adult survivors from a general intensive care unit were evaluated three months after discharge in a post-intensive care unit outpatient multidisciplinary clinic over a period of 6 years (2008-2014) in a University Hospital in southern Brazil. RESULTS A total of 688 out of 1945 intensive care unit survivors received care at the clinic. Of these, 45.2% had psychological disorders (particularly depression), 49.0% had respiratory impairments (abnormal spirometry), and 24.6% had moderate to intense dyspnea during daily life activities. Patients experienced weight loss during hospitalization (mean=11.7%) but good recovery after discharge (mean gain=9.1%), and 94.6% were receiving nutrition orally. One-third of patients showed a reduction of peripheral muscular strength, and 5.7% had moderate to severe tetraparesis or tetraplegia. There was a significant impairment in quality of life (SF-36), particularly in the physical and emotional aspects and in functional capacity. The economic impacts on the affected families, which were mostly low-income families, were considerable. Most patients did not have full access to rehabilitation services, even though half of the families were receiving financial support from the government. CONCLUSIONS A significant number of intensive care unit survivors evaluated 3 months after discharge had psychological, respiratory, motor, and socioeconomic problems; these findings highlight that strategies aimed to assist critically ill patients should be extended to the post-hospitalization period and that this problem is particularly important in low-income populations.
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Affiliation(s)
- Péricles A.D. Duarte
- Unidade de Terapia Intensiva Geral, Hospital Universitario do Oeste do Parana, Cascavel, PR, BR
- *Corresponding author. E-mail:
| | | | - Silvana Trilo Duarte
- Departamento de Fonoaudiologia, Hospital Universitario do Oeste do Parana, Cascavel, PR, BR
| | - Sheila Taba
- Departamento de Psicologia, Hospital Universitario do Oeste do Parana, Cascavel, PR, BR
| | | | - Erica Fernanda Osaku
- Unidade de Terapia Intensiva Geral, Hospital Universitario do Oeste do Parana, Cascavel, PR, BR
- Departamento de Fisioterapia, Hospital Universitario do Oeste do Parana, Cascavel, PR, BR
| | - Claudia Rejane Lima Macedo Costa
- Unidade de Terapia Intensiva Geral, Hospital Universitario do Oeste do Parana, Cascavel, PR, BR
- Departamento de Fisioterapia, Hospital Universitario do Oeste do Parana, Cascavel, PR, BR
| | | | - Daniela Prochnow Gund
- Departamento de Servico Social, Hospital Universitario do Oeste do Parana, Cascavel, PR, BR
| | - Amaury Cesar Jorge
- Unidade de Terapia Intensiva Geral, Hospital Universitario do Oeste do Parana, Cascavel, PR, BR
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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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Giacomelli IL, Steidle LJM, Moreira FF, Meyer IV, Souza RG, Pincelli MP. Hospitalized patients with COPD: analysis of prior treatment. J Bras Pneumol 2015; 40:229-37. [PMID: 25029645 PMCID: PMC4109194 DOI: 10.1590/s1806-37132014000300005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/26/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Although COPD is a prevalent disease, it is undertreated, and there are no available data regarding previous treatment of COPD in Brazil. This study aimed to determine the appropriateness of maintenance treatment in COPD patients prior to their hospitalization and to identify variables associated with inappropriate treatment. METHODS This was an observational, cross-sectional, analytical study involving 50 inpatients with COPD at two hospitals in the city of Florianópolis, Brazil. The patients completed a questionnaire on parameters related to the maintenance treatment of COPD. Non-pharmacological management and pharmacological treatment were assessed based on the recommendations made by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2011 and by the Brazilian National Ministry of Health in the chronic respiratory diseases section of its Caderno de Atenção Básica (CAB, Primary Care Guidebook). RESULTS In most of the patients, the COPD was classified as being severe or very severe. Regarding non-pharmacological management, 33% of the patients were smokers, only 32% had been advised to receive the flu vaccine, 28% had received pneumococcal vaccine, and only 6.5% of the patients in the B, C, and D categories received pulmonary rehabilitation. Regarding GOLD and CAB recommendations, pharmacological treatment was inappropriate in 50% and 74% of the patients, respectively. Based on GOLD recommendations, 38% were undertreated. A low level of education, low income, not receiving oxygen therapy, and not receiving the flu vaccine were associated with inappropriate treatment. CONCLUSIONS The application of various non-pharmacological management recommendations was unsatisfactory. Regarding the GOLD recommendations, the high rate of inappropriate maintenance treatment was mainly due to undertreatment. In Brazil, even in severe COPD cases, optimizing treatment to achieve greater benefits continues to be a challenge.
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