Comorbidities and Readmissions in Survivors of Acute Hypercapnic Respiratory Failure

Abstract

Chronic obstructive pulmonary disease (COPD) is defined by chronic airflow obstruction, but is presently considered as a complex, heterogeneous, and multicomponent disease in which comorbidities and extrapulmonary manifestations make important contributions to disease expression. COPD-related hospital readmission. In particular frequent intensive care unit (ICU) readmissions for exacerbations represent a major challenge and place a high burden on patient outcomes and health-related quality of life, as well as on the healthcare system.In this narrative review, we first address major and often undiagnosed comorbidities associated with COPD that could have an impact on hospital readmission after an index ICU admission for acute hypercapnic respiratory failure. Some guidance for treatment is discussed. Second, we present predictors of hospital and ICU readmission and discuss various strategies to reduce such events.There is a strong rationale to detect and treat major comorbidities early after index ICU admission for acute hypercapnic respiratory failure. It still remains unclear, however, if a comprehensive and holistic approach to comorbidities in frail patients surviving hypercapnic respiratory failure can efficiently reduce the readmission rate.

Symptomatic response to CPAP in obstructive sleep apnea versus COPD- obstructive sleep apnea overlap syndrome: Insights from a large national registry

“…Our results suggests that some OSA phenotypes such as minimally symptomatic OVS patients still benefit from CPAP therapy to improve OSA-related symptoms that may have been attributed to COPD. Our findings may be of particular interest for OVS patients, who often represent a “silent population” of unrecognized and undertreated comorbid OSA [ 7 , 8 , 25 ].…”

“…To determine the factor associated with the symptomatic response, multiples logistic regression models were performed for all symptoms related to OSA as a dependent variable and adjusted for age, gender, BMI, residual AHI and CPAP adherence after verification for the absence of collinearity. As log linearity was not verified for age and BMI, these variables were transformed into categorical variables (for age: <56 years old, [56, 65], [65, 72] and greater than 72 years old; for BMI: <25 normal, [ 25 – 30 ] overweight, [30–35] obese and > = 35 extremely obese). Missing values were observed for age and CPAP adherence and thus multiple imputations were performed to account for these.…”

How to ventilate obstructive and asthmatic patients

“…A striking feature of patients treated with NIV or invasive ventilation is the high rate of ICU or hospital readmissions [95]. At least 50% of patients surviving an ICU stay will be readmitted within a year, and this percentage can reach 80% in some studies.…”