Assessment of In-Hospital Mortality and the Need for Mechanical Ventilation in Acute Exacerbations of COPD: A 2-Years Prospective In-Hospital Observational Study

Elsokkary, Raafat; Ghanem, Maha; Metwally, Mohamed; Abdelaleem, Nermeen

doi:10.1378/chest.2274258

Cited by 2 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is useful to consider possible reasons why the six variables in the new prediction score correlate with in-hospital mortality in AECOPD. Urea has previously appeared as an important predictor of poor outcome in respiratory disease, reflect acute kidney injury resulting from volume depletion due to hyperventilation [8][9][10][11][12][13]. Confusion, marker of poor outcome in community acquired pneumonia, arise in AECOPD due to hypercapnia.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of CAUDA 70 Score in acute exacerbation of chronic obstructive pulmonary disease

Purna¹,

K²,

Reddy³

et al. 2020

IJIRM

View full text Add to dashboard Cite

Background: Physicians lack a robust and validated method of measuring severity or predicting poor outcome in patients with acute exacerbation of COPD (AECOPD). To study the prognosis in COPD patients with acute exacerbation using CAUDA 70 score. Materials and Methods: 104 patients of age more than 40 years with acute exacerbation of COPD admitted department of respiratory medicine, narayana medical college and hospital, Nellore. CAUDA 70: C: Confusion, Acidosis (pH <7.35), Urea >7mmol/L, MRC Dyspnoea score >4, Albumin <35g/L, Age >70 years. One point was assigned to each variable present, giving a six point scoring system. The patients were followed up upto discharge and the outcome of the patients was correlated with the score to analyse prognosis. Results: 29(27.8%) patients obtained score upto 2. In these patients, 24 (82.75%) recovered without ventilation, 5 (17.24%) required NIV and no patients required invasive ventilation and there were no deaths in patients with this score. 75(72.2%) patients obtained scores of 3 to 6. In these, 48(64%) patients required NIV, 15(20%) patients required invasive ventilation, 4 (5.3%) patients died and only 8 (10.66%) patients recovered without any ventilation. Conclusions: CAUDA 70 score proved to be an effective scoring system in predicting the prognosis in Acute Exacerbation of COPD patients.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Of the four, CAUDA 70 score gave good results in predicting need for mechanical ventilation and mortality. They proved that CAUDA 70 score 3 and above have high mortality and recommended the need for mechanical ventilation [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Assessment of CAUDA 70 Score in acute exacerbation of chronic obstructive pulmonary disease

Purna¹,

K²,

Reddy³

et al. 2020

IJIRM

View full text Add to dashboard Cite

show abstract

“…The decision to return to MV was made by jointly by the RT and the attending physician (both blinded to NIF results) based on signs of poor tolerance: S a O 2 < 90% with F i O 2 >0.4; P a CO 2 >55 mmHg or increased by ≥10 mmHg; arterial pH < 7.33; RR > 35 breaths/min or increased by 50% for ≥5 min; heart rate (HR) >140 beats/min or increased/decreased by >20%; mean arterial pressure >130 mmHg or <70 mmHg; or the presence of agitation, diaphoresis, disorientation, or depressed mental status. [ 14 ] The patients who demonstrated one of these signs during the SBT were considered a failed wean and returned to ventilatory support. [ 16 ]…”

Section: Methodsmentioning

confidence: 99%

“…[ 9 10 11 12 13 ] Exacerbations may lead to acute respiratory failure requiring noninvasive ventilation (NIV) or, in more severe cases, invasive mechanical ventilation (IMV). Although various prognostication tools have attempted to predict IMV needs,[ 14 ] this remains largely a clinical decision. IMV is associated with a myriad of complications for patients, including increased exposure to nosocomial infections,[ 15 ] barotrauma and ventilatory-induced lung injury,[ 16 17 ] hemodynamic compromise,[ 18 19 ] diaphragmatic and limb muscle weakness,[ 20 21 22 ] organ dysfunction,[ 23 24 25 ] neurological and psychological sequela,[ 26 27 ] protracted hospital and intensive care unit (ICU) LOS, and increased mortality.…”

Section: Introductionmentioning

confidence: 99%

Disease specific thresholds for determining extubation readiness: The optimal negative inspiratory force for chronic obstructive pulmonary disease patients

Vahedian‐Azimi

Bashar

Quinn

et al. 2020

Int J Crit Illn Inj Sci

View full text Add to dashboard Cite

Objectives: The negative inspiratory force (NIF) has been used to help clinicians predict a patient's likelihood of successful liberation from mechanical ventilation (MV). However, the utility of the traditional threshold of ≤−30 cmH 2 O may not be appropriate for patients with chronic obstructive pulmonary disease (COPD). This study aims to define the optimal predictive NIF threshold for COPD patients. Methods: A prospective-observational multi-center study was conducted in intensive care units of six academic medical centers. All patients had COPD and were intubated for hypercapnic respiratory failure. The process of weaning from MV was conducted according to the defined hospital protocol. NIF was measured after 120 min of spontaneous breathing trial (SBT). The sensitivity, specificity, positive, and negative predictive value (PPV, NPV), positive and negative likelihood ratios (LR+, LR−) were calculated, and the diagnostic accuracy recorded. Results: A total of 90 patients with COPD (39 males and 51 females) were included. Of these, 43 patients (47.8%) were successfully extubated whereas 47 patients (52.2%) failed SBT or required re-intubation ( P = 0.654). The threshold value of ≤−25 cmH 2 O offered the optimal performance in COPD patients: area under the receiver operating characteristic (ROC) curves ROC curves 0.836, sensitivity 95.0%, specificity 86.0%, PPV 84.4%, and NPV 95.6%., LR+ 6.79, LR− 0.06, and the diagnostic accuracy 90.7%. Conclusions: In mechanically ventilated COPD patients with hypercapnic respiratory failure, the NIF threshold of ≤−25 cmH 2 O was a moderate-to-good predictor for successful ventilator liberation, and outperforms the traditional threshold of ≤−30 cmH 2 O.

show abstract

Assessment of In-Hospital Mortality and the Need for Mechanical Ventilation in Acute Exacerbations of COPD: A 2-Years Prospective In-Hospital Observational Study

Cited by 2 publications

References 0 publications

Assessment of CAUDA 70 Score in acute exacerbation of chronic obstructive pulmonary disease

Assessment of CAUDA 70 Score in acute exacerbation of chronic obstructive pulmonary disease

Disease specific thresholds for determining extubation readiness: The optimal negative inspiratory force for chronic obstructive pulmonary disease patients

Contact Info

Product

Resources

About