Chronic obstructive pulmonary disease exacerbation in the intensive care unit: clinical, functional and quality of life at discharge and 3 months of follow up

Abstract

ObjectiveThe 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.MethodsThis 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.ResultsThere 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.ConclusionDespite 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.

Cognitive function following pulmonary rehabilitation and post-discharge recovery from exacerbation in people with COPD

“…Dodd et al [11] also found no improvement in cognitive performance at 3-months post-discharge using a comprehensive neuropsychological assessment. However, there are inconsistencies in methodology across studies and, as such, other studies have shown an improvement in cognition following recovery [15,17,18]. These methodological differences make direct comparisons between studies difficult, as the timings of the baseline assessment (e.g.…”

“…Processing speed, language and attention have all found to be impaired following hospitalisation for an exacerbation [11,13,17], however the recovery of cognitive performance and other health markers 1-3 months post-discharge is unclear. Viana et al [15] identified a significant improvement from discharge to the stable phase, however all patients remained mildly cognitively impaired following a 3-month recovery period. This CI could influence decision-making and self-management, such as a patient's decision to accept the offer of pulmonary rehabilitation (PR).…”

“…Dodd et al [11] were first to assess cognitive changes following recovery post-discharge, identifying no improvement. Although the natural recovery of symptoms, physiology and health-related quality of life post-exacerbation has been documented [15,16], the recovery of cognition in relation to other health markers is less consistent [11,15,17,18]. Studies have identified the improvement of lung function, dyspnoea and COPD symptoms following recovery from AECOPD [15,17,18], and Dodd et al [11] found an association between health-related quality of life and cognitive impairment at the time of exacerbation, but a complete assessment is yet to be explored in a single cohort.…”

“…Although the natural recovery of symptoms, physiology and health-related quality of life post-exacerbation has been documented [15,16], the recovery of cognition in relation to other health markers is less consistent [11,15,17,18]. Studies have identified the improvement of lung function, dyspnoea and COPD symptoms following recovery from AECOPD [15,17,18], and Dodd et al [11] found an association between health-related quality of life and cognitive impairment at the time of exacerbation, but a complete assessment is yet to be explored in a single cohort. Processing speed, language and attention have all found to be impaired following hospitalisation for an exacerbation [11,13,17], however the recovery of cognitive performance and other health markers 1-3 months post-discharge is unclear.…”