Hospital and 1-Year Survival of Patients Admitted to Intensive Care Units with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Seneff, Michael G.; Wagner, Douglas P.; Wagner, Randall P.; Zimmerman, Jack E.; Knaus, William A.

doi:10.1097/00132586-199610000-00023

Cited by 151 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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confidence: 65%

“…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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confidence: 99%

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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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confidence: 65%

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confidence: 99%

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

et al. 2011

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“…Additionally, according to a univariate analysis, we detected two statistically significant predictors of the need to initiate NIV: PaCO2 and FEV1% predicted. It is reasonable that both the PaCO2 and FEV1% predicted, which are established prognostic factors in patients with COPD, are also predictors of the need to initiate NIV during exacerbation, given that the need for NIV support implies the development of severe respiratory failure associated with a poor prognosis (1,(24)(25)(26)(27)(28)(29). However, it is noteworthy that, in the multivariate logistic regression analysis, the severity of airway obstruction assessed according to the FEV1% predicted was no longer identified as a predictor.…”

Section: Discussionmentioning

confidence: 98%

“…Consequently, the PaCO2 is regarded to be a poor prognostic indicator in general and has been demonstrated to be associated with the development of COPD-AE (1,7,(24)(25)(26)(27)(28)(29)(30). However, the majority of studies have focused on severely hypoxemic patients requiring NIV or patients who had previously experienced COPD-AE.…”

Section: Discussionmentioning

confidence: 99%

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

et al. 2013

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Objective Predictors of the need to initiate noninvasive ventilation (NIV) in stable COPD outpatients with acute exacerbation of chronic obstructive pulmonary disease (COPD-AE) are insufficiently defined. The objective of this study was to investigate predictors of the need to initiate NIV in stable COPD-AE outpatients. Methods A total of 140 consecutive stable COPD outpatients who were hospitalized for COPD-AE for the first time were retrospectively examined. Demographic and clinical parameters measured in the stable state were evaluated, including data for arterial blood gases, the pulmonary function, body mass index and dyspnea scores. Results Of the 140 patients included, NIV was used in 32 (23%) patients. In a univariate Cox proportional hazards analysis, the baseline partial pressure of arterial carbon dioxide (PaCO2) (hazard ratio (HR), 1.14 per mmHg; 95% confidence interval (CI), 1.08-1.21) and forced expiratory volume in one second (FEV1)% predicted (HR, 1.03 per %; 95% CI, 1.01-1.05) were identified to be significant predictors. A multivariate logistic regression analysis showed only the PaCO2 (HR, 1.18 per mmHg; 95% CI, 1.12-1.26) to be a significant predictor. Conclusion Our results suggest that the PaCO2 measured in the stable state is an independent significant predictor of the need to initiate NIV in COPD-AE patients who are hospitalized for the first time.

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“…Exacerbations are also associated with significant mortality and morbidity [51][52][53]. In addition, recent data from prospective studies show that exacerbation frequency contributes to the decline in lung function in patients with COPD [54].…”

Section: Effect Of Laba/ics Therapy On Exacerbationsmentioning

confidence: 99%

Effective management of COPD in primary care — the role of long-acting beta agonist/inhaled corticosteroid combination therapy

Schayck

Reid

2006

Primary Care Respiratory Journal

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Summary Chronic obstructive pulmonary disease (COPD) is the internationally preferred term for chronic, progressive lung disorders which are characterised by airflow limitation that is not fully reversible. The symptoms of COPD -including breathlessness, cough, excessive sputum production and reduced muscle tone and muscle wasting -reflect the complex pathophysiology of the disease. In order to address these symptoms, treatment regimens should take into account the multiple components that contribute to COPD. Clinical evidence has emerged indicating that, especially in patients with severe COPD, long-acting beta 2 -agonists (LABAs) and inhaled corticosteroids (ICS) result in improvements in symptoms, reduce the frequency and severity of exacerbations, and improve health-related quality of life. This review evaluates the clinical evidence for the potential of LABA/ICS treatment to address the symptoms of COPD and whether combination therapy of this nature adds significant benefit to patients.

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Hospital and 1-Year Survival of Patients Admitted to Intensive Care Units with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Cited by 151 publications

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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

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Effective management of COPD in primary care — the role of long-acting beta agonist/inhaled corticosteroid combination therapy

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