Predictors of Survival in Patients Receiving Domiciliary Oxygen Therapy or Mechanical Ventilation

Chailleux, E; Fauroux, Brigitte; Binet, Françoise; Dautzenberg, Bertrand; Polu, J. M.

doi:10.1378/chest.109.3.741

Cited by 224 publications

(192 citation statements)

References 20 publications

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“…This suggests a link between malnutrition and respiratory mechanical load independent of the specific cause of the disease. CRF is known to exert a detrimental effect on long-term outcome in various pulmonary disorders (Chailleux et al, 1996), but only limited data are available regarding the occurrence of CRF in relation to body composition. In COPD, we found values of BMI o20 kg/m 2 in about 16% of patients, similar to values observed in patients with COPD recruited for negative pressure ventilation (GrayDonald et al, 1996) or with current LTOT (Chailleux et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

Nutritional depletion and its relationship to respiratory impairment in patients with chronic respiratory failure due to COPD or restrictive thoracic diseases

et al. 2007

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Objective: While malnutrition, especially fat-free mass index (FFMI), is a predictor for mortality in chronic obstructive pulmonary disease (COPD), less information on prevalence and mechanisms is available in patients with chronic respiratory failure (CRF) due to restrictive thoracic diseases (RTD). Design and setting: Cross-sectional study of patients consecutively admitted to an in-patient primary pulmonary centre. Subjects: One hundred and thirty-two patients (30% RTD; 70% COPD) with CRF and intermittent non-invasive positive pressure ventilation. Interventions: Malnutrition was quantified by bioelectrical impedance analysis or body mass index (BMI), and its relationship to laboratory, lung function, inspiratory muscle and blood gas parameters and 6-min walking distance (6-MWD) was assessed. Results: Malnutrition in terms of BMIo20 kg/m 2 occurred in 16.1% of patients with COPD but none of those with RTD. FFMIo17.4 (o15.0 in female patients) kg/m 2 was found in 35.4 and 30.7%, respectively. FFMI was correlated with airway obstruction (sR aw , r ¼ À0.50; FEV 1 /VC, r ¼ À0.28; Pp0.01 each) and lung hyperinflation (intrathoracic gas volume, r ¼ À0.41; total lung capacity (TLC), r ¼ À0.50; Pp0.001 each) in COPD, and with lung restriction in RTD (TLC, r ¼ 0.40; P ¼ 0.011). Furthermore, malnourished patients showed a higher inspiratory load (P 0.1 ) and reduced 6-MWD in both groups. In COPD, only hyperinflation and P 0.1 were independently related to FFMI. Conclusions: Malnutrition as indicated by low FFMI was similarly prevalent in patients with CRF and COPD or RTD, but inadequately represented by BMI. The correlations between lung function impairments specific for the disease and FFMI emphasized the link between malnutrition and respiratory mechanical load irrespective of its aetiology.

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Section: Discussionmentioning

confidence: 99%

Nutritional depletion and its relationship to respiratory impairment in patients with chronic respiratory failure due to COPD or restrictive thoracic diseases

et al. 2007

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“…The underlying pulmonary disease and the stage of the disease is associated with different risks of cachexia. In the study by CHAILLEUX et al [15] where 26,140 patients were followed for 10 yrs, the prevalence of nutritional depletion differed largely in relation to the aetiology of chronic respiratory failure. For example, prevalence of undernutrition defined by a body weight <90% of IBW was 43% in patients with bronchiectasis, 65% in emphysema, 33% in chronic bronchitis, and 28% in IPF patients.…”

Section: Discussionmentioning

confidence: 99%

“…m -2 [4,5,7,13]. In COPD patients, the prevalence of nutritional depletion increases with the degree of bronchial obstruction [8,10,14,16,17], the level of hypoxaemia [8,15] and the subtype of COPD, emphysema patients being more depleted [14]. Hypoxaemia per se modifies muscle mass through a sharp decline in protein synthesis so that oxygen supply can adapt to demand [18].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and consequences of nutritional depletion in lung transplant candidates

Schwebel

Pin²,

Barnoud³

et al. 2000

Eur Respir J

107

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Nutritional status was studied in lung transplant (LT) candidates. The hypotheses were that nutritional depletion was highly prevalent and lean body mass depletion was a risk factor for a higher mortality both before and after LT.Of 78 consecutive patients listed for LT, 16 (21%) died while on the waiting list, eight (10%) were alive awaiting LT, and 54 (69%) received a graft. Mean age was 42.3 4.4 (mean SD). Thirty-eight per cent had a diagnosis of bronchiectasis or cystic fibrosis (BRO/CF), 33% of emphysema, 20% of idiopathic pulmonary fibrosis (IPF) and 8% of primary pulmonary hypertension. Body mass index (BMI) was 20.4 4.3 kg . m 2 , weight was 87.9 16.6% of ideal body weight (IBW).Patients were classed into four nutritional groups according to IBW and creatinine height index (CHI): I: weight <90% IBW and CHI <60% of predicted (28% of cases); II: weight <90% IBW and CHI $60% (27%); III: weight $90% IBW and CHI <60% (17%); IV: weight $90% IBW and CHI $60% (28%). Overall, 72% were depleted corresponding to groups I, II and III. Lean body mass depletion occurred despite normal weight in 17% of the cases (group III). Subjects with BRO/CF were mostly in groups I, II, III whereas IPF were concentrated in group III. Lean body mass depletion was associated with more severe hypoxaemia, reduced 6-minute walking distance and a higher mortality while awaiting. After LT, duration of mechanical ventilation, time spent in intensive care unit (ICU) was related to initial body composition. Survival after LT was lowest in group III.To conclude, nutritional depletion in lung transplant candidates is highly prevalent and should be more precisely assessed with a special reference to lean body mass since it has specific consequences both while awaiting and after lung transplant. Attempts should be made to increase lean body mass before lung transplant. Eur Respir J 2000; 16: 1050±1055.

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“…Different groups have demonstrated that the long-term outcome of home nocturnal nasal intermittent positive pressure ventilation (nNIPPV) is good in these patients [5,6]. Nonetheless, nowadays, the majority of these patients are still treated with long-term oxygen therapy (LTO) [7,8]. In a French Antadir analysis published in 1996 [8], 69% of 662 patients with kyphoscoliosis were treated with LTO alone and only 31% with ventilation.…”

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confidence: 99%

“…Nonetheless, nowadays, the majority of these patients are still treated with long-term oxygen therapy (LTO) [7,8]. In a French Antadir analysis published in 1996 [8], 69% of 662 patients with kyphoscoliosis were treated with LTO alone and only 31% with ventilation. Survival of patients with kyphoscoliosis treated by ventilation was better: their risk of death (taking age, sex, body mass index, partial pressure of oxygen (PO 2 ), partial pressure of carbon dioxide (PCO 2 ), forced expiratory volume in one second (FEV1), vital capacity (VC) and FEV1/VC into account) was 40% of that of those treated initially with LTO alone.…”

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confidence: 99%

Treatment of chronic respiratory failure in kyphoscoliosis: oxygen or ventilation?

Buyse¹,

Meersseman²,

Demedts³

2003

Eur Respir J

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Patients with kyphoscoliosis and chronic respiratory insufficiency are treated either with home oxygen therapy or ventilation. Kyphoscoliotic patients demonstrate impaired ventilatory mechanics, consequently ventilation seems to be the treatment of choice. Yet, no randomised controlled trials (CRT) exist to prove it.Most investigators find it difficult to ethically justify a CRT. Therefore, the current authors performed the following retrospective study: survival and pulmonary function were analysed in all consecutive kyphoscoliotic patients who started long-term oxygen therapy (LTO group; n=15, aged 62¡11 yrs (mean¡SD)) or LTO plus nocturnal nasal intermittent positive pressure ventilation (nNIPPV group; n=18, aged 61¡7 yrs) in the Dept of Pulmonology (University Hospital Gasthuisberg, Leuven) between 1990-2002.Prior to treatment partial pressure of oxygen (PO 2 ) was lower, partial pressure of carbon dioxide (PCO 2 ) tended to be higher and vital capacity (VC) tended to be lower in the nNIPPV group than in the LTO group (PO 2 5.9¡1 versus 6.7¡0.9 kPa (44¡8 versus 50¡7 mmHg), PCO 2 8¡1 versus 7.3¡0.9 kPa (60¡8 versus 55¡7 mmHg), VC 32¡12 versus 40¡16% predicted, or 645¡244 versus 970¡387 mL). In the nNIPPV group the 1-yr survival was higher (100% versus 66%). nNIPPV patients demonstrated an improvement in PO 2 (breathing air) z54%, PCO 2 (breathing air) -21%, VC z47% and maximal static inspiratory mouth pressurez33%; these improvements were absent in the LTO group.In conclusion, nocturnal nasal intermittent positive pressure ventilation, plus longterm oxygen therapy results in more favourable survival and changes in blood gases and respiratory function than long-term oxygen therapy alone. Eur Respir J 2003; 22: 525-528.

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Predictors of Survival in Patients Receiving Domiciliary Oxygen Therapy or Mechanical Ventilation

Cited by 224 publications

References 20 publications

Nutritional depletion and its relationship to respiratory impairment in patients with chronic respiratory failure due to COPD or restrictive thoracic diseases

Nutritional depletion and its relationship to respiratory impairment in patients with chronic respiratory failure due to COPD or restrictive thoracic diseases

Prevalence and consequences of nutritional depletion in lung transplant candidates

Treatment of chronic respiratory failure in kyphoscoliosis: oxygen or ventilation?

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