Acute respiratory failure secondary to chronic obstructive pulmonary disease treated in the intensive care unit: a long term follow up study

Breen, Dorothy; Churches, Tim; Hawker, Felicity; Torzillo, Paul J.

doi:10.1136/thorax.57.1.29

Cited by 117 publications

(135 citation statements)

References 30 publications

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“…(27) In order to assess quality of life, the Medical Outcomes Study 36-item Short-form Survey and its shortened version, comprising 12 items, can be used, as can other instruments, such as the high in the first year after hospital discharge. (2,3,9,16,17) In our study sample, mortality in the ICU was 27.3%, and the mortality rate in the first year after hospital discharge was 64.6%. At the time of the interview, two years after ICU discharge, 32% of our patients were alive.…”

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“…At the time of the interview, two years after ICU discharge, 32% of our patients were alive. In three other studies, (9,12,17) two-year survival was 51%, 44%, and 41.9%, respectively. The prognosis for such patients has been related to multiple factors, including pulmonary function test results, blood gas analysis results, degree of pulmonary hypertension, age, nutritional status, need for ventilatory support, and APACHE II score at ICU admission.…”

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“…The prognosis for such patients has been related to multiple factors, including pulmonary function test results, blood gas analysis results, degree of pulmonary hypertension, age, nutritional status, need for ventilatory support, and APACHE II score at ICU admission. (6,9,(16)(17)(18)(19) The reintegration of such patients into society, in terms of their ability to maintain adequate social interaction or perform their activities satisfactorily, has yet to be thoroughly investigated. (12)(13)(14)(15) There are few data regarding the need for hospital readmissions, the degree of dependence, the ability to remain self-sufficient, and the ability to resume work activities.…”

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Exacerbação aguda da DPOC: mortalidade e estado funcional dois anos após a alta da UTI

et al. 2011

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Objective: To assess ICU patients with COPD, in terms of in-hospital characteristics, two-year mortality and two-year functional status of survivors. Methods: A prospective cohort study involving patients with acute exacerbation of COPD admitted to the ICUs of two hospitals in the city of Porto Alegre, Brazil, between July of 2005 and July of 2006. At two years after discharge, survivors were interviewed by telephone in order to determine Karnofsky scores and scores on a scale regarding activities of daily living (ADL). Results: The sample comprised 231 patients. In-hospital mortality was 37.7%, and two-year post-discharge mortality was 30.3%. Of the 74 survivors, 66 were interviewed (89%). The mean age at ICU admission was 74 ± 10 years, and the mean Acute Physiology and Chronic Health Evaluation II score was 18 ± 7. Two or more comorbidities were present in 87.8% of the patients. Of the 66 interviewees, 57 (86.3%) lived at home, 58 (87.8%) were self-sufficient, 12 (18.1%) required oxygen therapy, and 4 (6.1%) still required ventilatory support. There was a significant reduction in the quality of life and autonomy of the survivors, as evidenced by the Karnofsky scores (85 ± 9 vs. 79 ± 11, p = 0.03) and ADL scale scores (29 ± 5 vs. 25 ± 7; p = 0.01), respectively. Conclusions: In this patient sample, two-year mortality was quite high. Although there was a noticeable reduction in the functional status of the survivors, they remained self-sufficient.Keywords: Pulmonary disease, chronic obstructive/mortality; Quality of life; Intensive care units. ResumoObjetivo: Determinar a taxa de mortalidade de pacientes com DPOC e avaliar o estado funcional dos sobreviventes dois anos após a alta da UTI. Métodos: Estudo de coorte prospectiva realizada nas UTIs de dois hospitais na cidade de Porto Alegre (RS) com pacientes com exacerbação aguda de DPOC e internados em UTI entre julho de 2005 e julho de 2006. Dois anos após a alta, os sobreviventes foram entrevistados via telefone. Os dados obtidos foram utilizados na determinação dos escores da escala de Karnofsky e de uma escala de atividades de vida diária (AVD). Resultados: Foram incluídos 231 pacientes. A mortalidade hospitalar foi de 37,7% e a mortalidade extra-hospitalar foi de 30,3%. Dos 74 sobreviventes, foram entrevistados 66 (89%). A média de idade dos pacientes no momento da internação na UTI era de 74 ± 10 anos e a do escore Acute Physiology and Chronic Health Evaluation II era de 18 ± 7. Tinham duas ou mais comorbidades 87,8% dos pacientes. Dos 66 entrevistados, 57 (86,3%) viviam em suas casas, 58 (87,8%) eram capazes de realizar seu autocuidado, 12 (18,1%) utilizavam oxigenoterapia, e 4 (6,1%) necessitavam suporte ventilatório. Houve uma significante redução na qualidade de vida e na autonomia, segundo os escores da escala de Karnofsky (85 ± 9 vs. 79 ± 11; p = 0,03) e de AVD (29 ± 5 vs. 25 ± 7; p = 0,01), respectivamente. Conclusões: A mortalidade desta amostra de pacientes foi muito elevada nos primeiros dois anos. Embora houvesse evidente redução do esta...

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“…[24][25][26][27] In these 18 patients were found the BMI and the MRC scores to be significantly higher than the other cases. These two variables seem to be predicting the length of the hospital stay and outcome of COPD.…”

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Acute exacerbation of chronic obstructive pulmonary disease: predictors of outcome: single center prospective study from India

Reddy

Polu

2016

Int J Adv Med

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“…13 Even prior to the widespread use of NIV the outcome of patients admitted to intensive care requiring mechanical ventilation was favourable, with over 70% hospital survival recorded in three studies from Australia and the USA. [14][15][16] Recent data from the 2003 Royal College of Physicians/British Thoracic Society audit of acute COPD admissions are less encouraging. In the total population of patients admitted to hospital, 15% died and 27% were readmitted in a 90-day period.…”

Section: Chronic Obstructive Pulmonary Diseasementioning

confidence: 99%

Recent advances in mechanical ventilation

Park

Griffiths

2005

Clinical Medicine

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Mechanical ventilation and critical care have their origins in the polio epidemics of the 1950s which were associated with a high incidence of respiratory failure. During this period, two important aspects of critical care were firmly established:• mechanical ventilatory support (both invasive and non-invasive) could improve survival in respiratory failure, and• ventilatory support was better provided by dedicated specialist units. Since the 1960s, the ability to provide invasive mechanical ventilation has continued to define intensive care unit (ICU) care and in most units at least 50% of admissions will receive such support.Until recently, the exclusive use of ventilators in ICUs (and theatres) promoted an understandable view that most general physicians needed little working knowledge of these devices. However, the development of non-invasive ventilation (NIV) on medical wards, as well as the widespread use of continuous positive airway pressure (CPAP), has significantly altered the situation. A basic understanding of ventilator and CPAP technology is now important to all those caring for the acutely ill. This article will provide a brief explanation of ventilatory modes and then review ventilatory support in two common conditions that cause respiratory failure on the ICU:• adult respiratory distress syndrome (ARDS), and• chronic obstructive pulmonary disease (COPD). Mechanical ventilators and modesVentilator technology can appear bewilderingly complex, a situation not helped by a lack of standardised terminology, with different manufacturers adopting alternative terms for the same mode of ventilation. Table 1 presents a summary of common terms and modes. Like video recorders, modern ICU-based ventilators often have more features than appear strictly necessary. However, this makes them very flexible: for example, it is no longer necessary to have separate machines for pressure-and volumedriven ventilation, with one machine able to fulfil both roles.A ventilator is best considered as a black box with the internal mechanics irrelevant to the operation of the system.The most important and defining feature of a ventilator is that it can cycle between inspiration and expiration. This distinguishes it from a CPAP machine with which there is no cycling. CPAP machines are therefore not ventilatorsdespite their similar appearance -and should not be confused with those devices. Volume or pressure modeA further important division is in the choice of volume or pressure as the set variable that determines the delivery of the air/oxygen mixture to the patient. In volume cycling modes, tidal volume (V T ) is preset, which then generates an airway pressure (depending on airway resistance and lung compliance). In pressure cycling mode, an inspiratory pressure is preset and V T is delivered, which again varies depending on airway resistance and lung compliance. Neither method is superior in terms of gas delivery and no study has conclusively demonstrated a better outcome with either mode. ControlsFew additional controls are ne...

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Acute respiratory failure secondary to chronic obstructive pulmonary disease treated in the intensive care unit: a long term follow up study

Cited by 117 publications

References 30 publications

Exacerbação aguda da DPOC: mortalidade e estado funcional dois anos após a alta da UTI

Exacerbação aguda da DPOC: mortalidade e estado funcional dois anos após a alta da UTI

Acute exacerbation of chronic obstructive pulmonary disease: predictors of outcome: single center prospective study from India

Recent advances in mechanical ventilation

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