Determinants of Weaning and Survival Among Patients with COPD Who Require Mechanical Ventilation for Acute Respiratory Failure

Menzies, Richard; Gibbons, William J.; Goldberg, Peter

doi:10.1378/chest.95.2.398

Cited by 228 publications

(140 citation statements)

References 20 publications

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“…Although these changes were reduced in the group for whom noninvasive positive pressure ventilation was prescribed, the same relative impact of acidosis was present. Studies looking at other factors related to outcome suggest that, although baseline lung function is a determinant, the patients9 overall functional status is a significant predictor of their 1-yr mortality [6], and this is in agreement with recent studies which have shown a significant increase in mortality for each point decrement in health status [7].…”

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confidence: 88%

Respiratory failure in chronic obstructive pulmonary disease

Calverley¹

2003

European Respiratory Journal

103

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Respiratory failure in chronic obstructive pulmonary disease. P.M.A. Calverley. #ERS Journals Ltd 2003. ABSTRACT: Respiratory failure is still an important complication of chronic obstructive pulmonary disease (COPD) and hospitalisation with an acute episode being a poor prognostic marker. However, other comorbid conditions, especially cardiovascular disease, are equally powerful predictors of mortality.The physiological basis of acute respiratory failure in COPD is now clear. Significant ventilation/perfusion mismatching with a relative increase in the physiological dead space leads to hypercapnia and hence acidosis. This is largely the result of a shift to a rapid shallow breathing pattern and a rise in the dead space/tidal volume ratio of each breath. This breathing pattern results from adaptive physiological responses which lessen the risk of respiratory muscle fatigue and minimise breathlessness.Treatment is directed at reducing the mechanical load applied to each breath, correcting specific precipitating factors, e.g. bacterial infection, and maintaining gas exchange. Both bronchodilators and oral corticosteroids can improve spirometric results in exacerbations of COPD and should be routinely offered to patients with respiratory failure. Controlled oxygen is still not always prescribed appropriately and high inspired oxygen concentrations can lead to severe acidosis by either worsening ventilation/perfusion mismatching and/or inducing a degree of hypoventilation. Ventilatory support using noninvasive ventilation has revolutionised the approach to these patients.Acute respiratory failure due to chronic obstructive pulmonary disease remains a common medical emergency that can be effectively managed. More attention should be focused on the prevention of these episodes and identifying the factors which cause early relapse. Eur Respir J 2003; 22: Suppl. 47, 26s-30s.

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supporting

confidence: 88%

Respiratory failure in chronic obstructive pulmonary disease

Calverley¹

2003

European Respiratory Journal

103

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“…Validated questions were used about general health, smoking status, accommodation, home ownership, home heating, 21 self-reported damp, 22 ownership of household items, social support, 21 ethnicity, 23 and country of birth. Patients' functional scores were also derived, 24 and data were obtained from patients about their demographic characteristics, economic status, health service use, and use of medications.…”

Section: Data Collectionmentioning

confidence: 99%

Effect of social factors on winter hospital admission for respiratory disease: a case–control study of older people in the UK

Jordan¹,

Hawker²,

Ayres³

et al. 2008

Br J Gen Pract

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Every winter, hospitals in the UK and other developed countries experience a surge in respiratory admissions. Ecological studies suggest that social circumstances may be an important determinant. AimTo establish the most important factors associated with winter hospital admissions among older people presenting with acute respiratory disease, especially the relative effect of social factors. Design of studycase-control study. SettingSeventy-nine general practices in central England. MethodOf a cohort of patients consulting medical services with lower respiratory tract infection or exacerbation of chronic respiratory disease, 157 hospitalised cases were compared to 639 controls. Social, medical, and other factors were examined by interview and GP records. ResultsMeasures of material deprivation were not significant risk factors for admission at either individual or area level, although social isolation (odds ratio [OR] 4.5; 95% confidence interval [CI] = 1.3 to 15.8) resulted in an increased risk of admission. The most important independent risk factor was the presence of chronic obstructive pulmonary disease (COPD; OR 4.0; 95% CI = 1.4 to 11.4), other chronic disease (OR 2.9; 95% CI = 1.2 to 7.0), or both (OR 6.7; 95% CI = 2.4 to 18.4). Being housebound was also an independent risk factor (OR 2.2; 95% CI = 1.0 to 4.8). ConclusionSocioeconomic factors had little relative effect compared with medical and functional factors. The most important was the presence of long-term medical conditions (especially COPD), being housebound, and having received two or more courses of oral steroid treatment in the previous year. This combination of factors could be used by primary medical services to identify older patients most vulnerable to winter admissions. Clinicians should ensure that patients with COPD are better supported to manage their condition.

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“…Finally, we formulated a lung improvement index (LII) representative of the overall lung response to treatment and medication, and a parameter m that corresponds to the rate of lung improvement and reflects the stability of lung-status with time. This chapter is based on our previous chapter [3] in the book on Human Respiration (edited by V. Kulish and published by WIT Press) and other works on this subject [4][5][6][7][8][9].…”

Section: Scope and Methodologymentioning

confidence: 99%