Early identification of patients at risk for failing non-invasive oxygen therapy has been challenging but is of important clinical benefit. The ROX (Respiratory rate-OXygentation) index, defined as the ratio of pulse oximetry/fraction of inspired oxygen to respiratory rate, has been shown to predict (HFNC) failure and risk of mechanical ventilation in patients with pneumonia. We aim to validate the ROX index in all adults admitted to the medical floor across all supplemental oxygen therapy modalities, not just HFNC, and risk of requiring mechanical ventilation. If validated, the goal would be to utilize the ROX index in a rescue alert system. METHODS: We performed a retrospective observational cohort study of adult patients admitted to a non-ICU, acute care medicine service over an 11 month period at a large academic hospital. A clustered logistic regression of daily worse ROX index was performed to estimate the risk of endotracheal intubation, and all-cause hospital mortality.
Idiopathic Pulmonary Fibrosis (IPF) is an Interstitial Lung Disease (ILD) with significant morbidity and mortality. Guidelines recommend frequent monitoring for disease progression, co-morbidities, and early referral to pulmonary rehabilitation and palliative care 1 . Previous studies have shown improved survival in patients with ILD cared for in dedicated ILD clinics in tertiary care centers 2 . In May 2019, a dedicated weekly ILD clinic was established at the Hunter Holmes McGuire Veterans Affairs Medical Center. We performed a retrospective chart review to assess whether the ILD clinic improved adherence to guideline-based metrics in veterans with IPF. METHODS:A list of all patients on antifibrotic therapy, reflecting most individuals with IPF at our medical center, was obtained from the pharmacy. We then performed a chart-based retrospective review comparing the frequency of guideline-recommended monitoring and discussions performed for patients seen in ILD clinic compared to the general pulmonary clinic. The ILD clinic consisted of a dedicated Pulmonologist and Respiratory Therapist. Each new patient seen in the clinic completed an extensive medical, exposure and family history. A 6-minute walk test (6MWT) and bedside spirometry was attempted every patient visit. Charts from May 1, 2019 to March 31, 2020 were reviewed, reflecting the period from when ILD clinic was initiated until usual clinic operations were halted due to the COVID-19 pandemic.RESULTS: A total of 20 IPF patients were identified; 7 were followed in the ILD clinic while the remaining 13 were seen in general pulmonary clinic. Individuals followed in the ILD clinic had closer monitoring of end points used to monitor for disease progression, such as spirometry and 6MWT, with both occurring every 6 months in 85.7% of patients. In the general pulmonary clinic, 46% had PFTs every 6 months while none had 6MWT every 6 months. Of the IPF patients seen in the ILD clinic, 100% underwent screening for sleep apnea, gastroesophageal reflux disease and hypoxia, while 46.2%, 84.6% and 76.9% respectively were screened in general pulmonary clinic. ILD clinic patients also had discussions regarding pulmonary rehab and goals of care, 100% and 42.9% of the time compared to 23% and 38.5% in those seen in general pulmonary clinic.CONCLUSIONS: ILD clinics, regardless of their association with a tertiary care center, can lead to improved monitoring of disease progression and co-morbidities in patients with IPF. Such dedicated care can also lead to more referrals to pulmonary rehab and palliative care. The key limitations to this study are the sample size and the retrospective design. In addition, we may not have captured patients with IPF who were not considered to be candidates for anti-fibrotic therapy.CLINICAL IMPLICATIONS: With minimal associated cost, dedicated ILD clinics, even those located in small healthcare systems, can improve care provided to patient's with IPF.1) Idiopathic pulmonary fibrosis: diagnosis and treatment. International Consensus Statement. A...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.