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Abstract

respectively. The mean age for men and women were 62.6 and 61.5, respectively. Several patients demonstrated multiple emboli; to wit, 273 distinct PEs were noted among the 160 individual patients. 107 right sided emboli were found (39.2%), 50 left sided (18.3%), and 116 patients demonstrated bilateral PEs (42.5%). Conclusions: Incidence of right-sided PE exceeded left-sided PE and bilateral involvement exceeded both. Additionally, PE were more common in lower segments (24.9%) than upper segments (17.6%). The increased size of the right lung compared to the left may contribute to the tendency of emboli to locate to the right side. The clinical significance of the right-sided preference suggests an elevated PE-associated mortality risk in patients with unilateral left lung disease.Learning Objectives: Treatment of Acute Exacerbated Chronic Obstructive Pulmonary Disease (AECOPD) consists of multiple therapies including systemic steroids. AECOPD may require hospitalization and mechanical ventilation. Controversial literature exists regarding optimal dosing and duration for steroid therapy. The primary objective was to clarify the dosing of methylprednisolone (MP) for AECOPD by assessing re-intubation rates within 30 days of extubation. Secondary objectives include ICU length of stay, time on mechanical ventilation, duration of steroid therapy, insulin requirements and mortality. Methods: A retrospective review of medical intensive care unit (MICU) patients admitted at WVU Healthcare from January 1, 2009 through December 31, 2014. Patients receiving ≥72 hr of MP during hospitalization were screened. Selected patients were stratified by the initial daily MP dosing regimen -(low dose-LD ≤ 160mg, medium dose-MD 161 -239mg and high dose-HD ≥ 240mg). Descriptive statistics were used for baseline characteristics and to compare variables between groups. Results: Total of 157 patients screened, 116 were enrolled (LD [n=47], MD [n=7] and HD [n=62]). Included patients had a history of smoking (29%), home oxygen therapy (46%) and diabetes (35%). Only 1% of patients (n=2) were re-intubated within 30 days of initial extubation and 2 patients died. There was no difference in ICU length of stay or days on the ventilator in all groups (3-6 days). Overall, patients received 7-9 days of therapy. Interestingly, 25% of patients had changes to insulin therapy and 11 patients (LD [n=4] and HD [n=7]) received an insulin drip. Conclusions: Results failed to demonstrate a difference in re-intubation rates between groups. No differences in ICU length of stay, time on ventilation, duration of steroid therapy, insulin requirements and mortality was seen. These results warrant prospective dose finding studies to determine the appropriateness of a LD regimen in order to achieve optimal clinical outcomes in this population.