Acute Exacerbations and Respiratory Failure in Chronic Obstructive Pulmonary Disease

MacIntyre, Neil R.; Huang, Y.-C. T.

doi:10.1513/pats.200707-088et

Cited by 128 publications

(98 citation statements)

References 80 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition to knowing the cause of respiratory tract infections, other precipitating causes may improve the treatment outcome [14]. COPD exacerbation treatment outcomes vary, depending on aggressiveness of the approach [8,15].…”

Section: W Reechaipichitkulmentioning

confidence: 99%

Precipitating causes and outcomes of chronic obstructive pulmonary disease exacerbation at a tertiary care center in northeast Thailand

Reechaipichitkul

2014

Asian Biomedicine

View full text Add to dashboard Cite

Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalization and economic burden. Frequent exacerbations impair quality of life and effect decline of lung function. Objective: We evaluated characteristics of COPD patients with frequent exacerbations. The precipitating causes, outcomes, hospital stay, and cost of admission were also determined. Methods: The study population included COPD patients admitted because of acute COPD exacerbation at Srinagarind Hospital between 1 January 2006 and 31 December 2010. Results: Over the 5-year period, 183 patients were admitted. Their mean age was 74.9 (SD 9.28) years and the male to female ratio was 170:13. Most patients (144; 79%) had one exacerbation per year and 39 (21%) had more than one per year. The group with more exacerbations, had a higher stage of the disease than those with only one exacerbation (p = 0.023), but there was no significant difference in the mortality rate (18% vs 14%, p = 0.53). A total of 245 episodes of acute exacerbation of COPD occurred in 183 patients. The mean duration of symptoms was 4.1 (SD 3.46) days. Forty-seven percent presented with Anthonisen type III, 42.4% with Anthonisen type II, and 10.6% with Anthonisen type I exacerbations. For 44 exacerbations (18%), the precipitating causes were not determined. The most common precipitating cause was pneumonia, which occurred in 90 episodes (36.7%). The second common was bronchitis (27.8%); followed by heart failure (8.2%), infected bronchiectasis (5.3%), diarrhea (1.2%), acute urinary retention (0.8%), unstable angina (0.4%), pneumothorax (0.4%), urinary tract infection (0.4%), atrial fibrillation (0.4%) and drug induced cough (0.4%). The organisms responsible for respiratory tract infection were identified in 31% cases of pneumonia and 18% of bronchitis cases. The top three common pathogens for pneumonia were Pseudomonas aeruginosa (9%), Acinetobacter baumannii (8%), and Klebsiella pneumoniae (8%). The top three common pathogens for bronchitis were P aeruginosa (7%), Haemophilus influenza (6%), and K pneumoniae (4%). About one quarter (25.3%) of acute exacerbations were complicated by respiratory failure. The mean duration of admission was 17.3 days (range 1-682 days). The mean cost of admission per exacerbation was 80,010 Thai baht (US $2,666) (range, 2,779-3,433,108 baht). The total cost for 245 exacerbations was 19.6 million baht ($653,000). Conclusion: Respiratory tract infections were common causes of COPD exacerbation and one quarter of which developed respiratory failure. Preventive measures such as vaccination, smoking cessation, lung rehabilitation, and appropriate drug use are helpful.

show abstract

Section: W Reechaipichitkulmentioning

confidence: 99%

Precipitating causes and outcomes of chronic obstructive pulmonary disease exacerbation at a tertiary care center in northeast Thailand

Reechaipichitkul

2014

Asian Biomedicine

View full text Add to dashboard Cite

show abstract

“…(3)(4)(5) The gradual deterioration typical of the disease can be interspersed with periods of acute worsening of the clinical and functional status of patients, known as episodes of COPD exacerbation, which can manifest as increased respiratory effort and respiratory failure, requiring ICU admission and ventilatory support. (6)(7)(8)(9) In the Brazilian literature, we found no reports of ICU admissions of COPD patients. Therefore, we studied a population of COPD patients admitted to the ICU of a tertiary referral hospital for respiratory diseases in the state of Santa Catarina, Brazil, in order to evaluate their characteristics and clinical course.…”

Section: Introductionmentioning

confidence: 97%

Características de pacientes com DPOC internados em UTI de um hospital de referência para doenças respiratórias no Brasil

et al. 2011

View full text Add to dashboard Cite

Objective: To report data regarding COPD patients admitted to the ICU of a referral hospital for respiratory diseases, including outcomes and treatment evaluation. Methods: Study of a series of patients with respiratory failure and COPD admitted to the ICU of Nereu Ramos Hospital, located in the city of Florianópolis, Brazil, between October of 2006 and October of 2007. Data related to demographics, causes of hospitalization, pharmacological treatment, ventilatory support, length of hospital stay, in-hospital complications, ICU mortality, and 28-day mortality were obtained from the medical charts of the patients. Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated. Mortality at 18 months was assessed by subsequent telephone calls. Results: During the study period, 192 patients were admitted to the ICU, 24 (12.5%) of whom were diagnosed with respiratory failure and COPD. The mean length of ICU stay was 12.0 ± 11.1 days. Noninvasive ventilation was used in 10 of the 24 patients (41.66%) and failed in 5 of those 10. Invasive mechanical ventilation (IMV) was used in a total of 15 patients (62.5%). Overall ICU mortality and 28-day mortality were 20.83% and 33.33%, respectively. However, 18-month mortality was 62.5%. Conclusions: Respiratory failure associated with COPD was responsible for 12.5% of the ICU admissions. Orotracheal intubation and IMV were necessary in 62.5% of the cases. The ICU mortality rate was in accordance with that predicted by the APACHE II scores. However, late mortality was high.Keywords: Epidemiology; Respiration, artificial; Respiratory insufficiency; Pulmonary disease, chronic obstructive; Intensive care units; Mortality. ResumoObjetivo: Relatar dados referentes às internações de pacientes com DPOC na UTI de um hospital de referência para doenças respiratórias, incluindo desfechos e avaliando seu atendimento. Métodos: Estudo de uma série de pacientes internados por insuficiência respiratória e DPOC na UTI do Hospital Nereu Ramos, localizado na cidade de Florianópolis (SC) no período entre outubro de 2006 e outubro de 2007. Dados demográficos, causas da internação, tratamento farmacológico, suporte ventilatório, duração e complicações da internação, mortalidade em UTI e mortalidade em 28 dias foram obtidos através de consulta aos prontuários médicos. O índice Acute Physiology and Chronic Health Evaluation II (APACHE II) foi calculado. A mortalidade em 18 meses foi avaliada através de posterior contato telefônico. Resultados: No período, foram internados 192 pacientes na UTI, 24 dos quais (12,5%) com insuficiência respiratória e DPOC. O tempo médio de internação na UTI foi de 12,0 ± 11,1 dias. A ventilação não invasiva foi utilizada em 10 dos 24 pacientes (41,66%) e falhou em 5/10. A ventilação mecânica invasiva (VMI) foi utilizada em 15 pacientes (62,5%). As taxas de mortalidade na UTI e aquela em 28 dias foram de 20,83% e 33,33%, respectivamente. Entretanto, decorridos 18 meses, a mortalidade foi de 62,5%. Conclusões: A insuficiência respiratória rela...

show abstract

“…The involvement of the entire multidisciplinary team is paramount to the successful application of NIV and to ensure enhanced patient outcomes. Hence, it is essential to ensure the collaboration of all members of the multidisciplinary team 7,43 .…”

Section: Multidisciplinary Team Approachmentioning

confidence: 99%

Developing a clinical pathway for non-invasive ventilation

Balfour

Coetzee

Heyns

2013

International Journal of Care Pathways

View full text Add to dashboard Cite

Acute Exacerbations and Respiratory Failure in Chronic Obstructive Pulmonary Disease

Cited by 128 publications

References 80 publications

Precipitating causes and outcomes of chronic obstructive pulmonary disease exacerbation at a tertiary care center in northeast Thailand

Precipitating causes and outcomes of chronic obstructive pulmonary disease exacerbation at a tertiary care center in northeast Thailand

Características de pacientes com DPOC internados em UTI de um hospital de referência para doenças respiratórias no Brasil

Developing a clinical pathway for non-invasive ventilation

Contact Info

Product

Resources

About