What happens to patients with COPD with long-term oxygen treatment who receive mechanical ventilation for COPD exacerbation? A 1-year retrospective follow-up study

Hajizadeh, Negin; Goldfeld, Keith; Crothers, Kristina

doi:10.1136/thoraxjnl-2014-205248

Cited by 30 publications

(15 citation statements)

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“…The prognosis for subjects who were discharged with STOT following hospitalization was poor. The overall 1-y survival rate of 61% for the nonpalliative subjects was comparable with previously reported data for subjects hospitalized for heart failure and COPD, which ranged from 56% to 67% [34][35][36][37] and from 55% to 78%, [38][39][40][41][42] respectively. A cohort study of a sample of Medicare beneficiaries Ͼ 65 y old from the United States reported 3-y mortality rate of 39.5% for those who were admitted to the ICU during hospitalization.…”

Section: Discussionsupporting

confidence: 87%

Post-Hospitalization Short-Term Oxygen Therapy: Use of a Clinical Management Pathway and Long-Term Follow-Up

2018

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BACKGROUND: Home oxygen therapy is commonly prescribed for patients who remain hypoxemic at hospital discharge, although evidence supporting this practice is lacking. This study aimed to evaluate oxygen prescription and follow-up for patients who were prescribed post-discharge short-term oxygen therapy (STOT) and to assess their long-term outcome. METHODS: A retrospective audit was undertaken of subjects prescribed STOT following hospitalization at a single site in Melbourne, Australia, between January 2011 and December 2015. During the study period, a designated clinical pathway for STOT prescription and follow-up after hospital discharge was in place. Chart review was performed to collect subject demographics and comorbidities, results of oxygen assessment (arterial blood gas and 6-min walk tests) and prescription, and results at follow-up re-assessment and mortality. RESULTS: Over five 5 years, 205 subjects were prescribed STOT upon hospital discharge. Common indications for oxygen treatment were chronic lung disease (54%) and dyspnea palliation (26%). Of the 152 subjects who were discharged with non-palliative oxygen therapy, 28% did not fulfil the recommended prescribing criteria or did not have recommended assessments. Among the 118 subjects who returned for re-assessment 4 weeks after initial oxygen provision, 47 (40%) did not fulfill criteria for long-term oxygen therapy. The 1-y cumulative survival rate for the study population was 56%. CONCLUSIONS: A significant proportion of subjects who were prescribed post-discharge STOT did not fulfill the recommended prescribing criteria. The long-term prognosis for subjects who were prescribed postdischarge STOT was poor.

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Section: Discussionsupporting

confidence: 87%

Post-Hospitalization Short-Term Oxygen Therapy: Use of a Clinical Management Pathway and Long-Term Follow-Up

2018

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“…These included one direct question about whether participants trusted the decision aid, one concerning confidence in the accuracy of the estimates given, and one asking whether participants thought the numbers could be wrong. Most patient participants (N=11; 84.6%), and all surrogate participants trusted the contents of the decision aid, stating that: they trusted the source of the information (both the fact that the decision aid was linked to our health system, and because the decision aid itself contains a resources section where we provide information on how the estimates were generated, including the sources from which the estimates were generated) 13 ; the information was consistent with what they had experienced; and the decision aid was not linked to any advertisements or corporate sponsors. However, on average, patient and surrogate participants stated that they were only about 60% sure (median: 50% and 70% for patient and surrogates) that the estimates given were correct, and almost all patient and surrogate participants stated that these numbers could be incorrect because: peoples’ outcomes vary; the research could be based on people with unspecified co-morbidities; or the information was inconsistent with prior experiences.…”

Section: Resultsmentioning

confidence: 99%

Other Ways of Knowing

et al. 2017

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Background Patients with advanced stage chronic obstructive pulmonary disease (COPD) may suffer severe respiratory exacerbations and need to decide between accepting life sustaining treatments versus foregoing these treatments (choosing comfort care only). We designed the InformedTogether decision aid to inform this decision, and describe results of a pilot study to assess usability focusing on participants’ trust in the content of the decision aid, acceptability, recommendations for improvement; and emotional reactions to this emotionally-laden decision. Methods Study participants (N=26) comprised of clinicians, patients, and surrogates viewed the decision aid, completed usability tasks, and participated in interviews and focus groups assessing comprehension, trust, perception of bias, and perceived acceptability of InformedTogether implementation. Mixed methods were used to analyze results. Results Almost all participants understood the gist (general meaning) of InformedTogether. However, many lower literacy participants had difficulty answering the more detailed questions related to comprehension, especially when interpreting icon arrays, and many were not aware that they had misunderstood the information. Qualitative analysis showed a range of emotional reactions to the information. Participants with low verbatim comprehension frequently referenced lived experiences when answering knowledge questions, which we termed “alternative knowledge”. Conclusion We found a range of emotional reactions to the information, and frequent use of alternative knowledge frameworks for deriving meaning from the data. These observations led to insights into the impact of lived experiences on the uptake of biomedical information presented in decision aids. Communicating prognostic information could potentially be improved by eliciting alternative knowledge as a starting ground to build communication, in particular for low literacy patients. Decision aids designed to facilitate shared decision making should elicit this knowledge and help clinicians tailor information accordingly.

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“…Previous studies have found the in-hospital mortality rate to be between 20–30% for patients requiring mechanical ventilation for COPD exacerbation [27–30]. In addition, patients with COPD have been found to have high neutrophil, macrophages, and CD8 + T cells in the lungs.…”

Section: Discussionmentioning

confidence: 99%

The effect of preexisting respiratory co-morbidities on burn outcomes

Knowlin

Stanford

Cairns

et al. 2017

Burns

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Introduction Burns cause physiologic changes in multiple organ systems in the body. Burn mortality is usually attributable to pulmonary complications, which can occur in up to 41% of patients admitted to the hospital after burn. Patients with preexisting comorbidities such as chronic lung diseases may be more susceptible. We therefore sought to examine the impact of preexisting respiratory disease on burn outcomes. Methods A retrospective analysis of patients admitted to a regional burn center from 2002–2012. Independent variables analyzed included basic demographics, burn mechanism, presence of inhalation injury, TBSA, pre-existing comorbidities, smoker status, length of hospital stay, and days of mechanical ventilation. Bivariate analysis was performed and Cox regression modeling using significant variables was utilized to estimate hazard of progression to mechanical ventilation and mortality. Results There were a total of 7640 patients over the study period. Overall survival rate was 96%. 8% (n=672) had a preexisting respiratory disease. Chronic lung disease patients had a higher mortality rate (7%) compared to those without lung disease (4%, p<0.01). The adjusted Cox regression model to estimate the hazard of progression to mechanical ventilation in patients with respiratory disease was 21% higher compared to those without respiratory disease (HR=1.21, 95% CI=1.01–1.44). The hazard of progression to mortality is 56% higher (HR=1.56, 95% CI=1.10–2.19) for patients with pre-existing respiratory disease compared to those without respiratory disease after controlling for patient demographics and injury characteristics. Conclusion Preexisting chronic respiratory disease significantly increases the hazard of progression to mechanical ventilation and mortality in patients following burn. Given the increasing number of Americans with chronic respiratory diseases, there will likely be a greater number of individuals at risk for worse outcomes following burn.

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What happens to patients with COPD with long-term oxygen treatment who receive mechanical ventilation for COPD exacerbation? A 1-year retrospective follow-up study

Cited by 30 publications

References 5 publications

Post-Hospitalization Short-Term Oxygen Therapy: Use of a Clinical Management Pathway and Long-Term Follow-Up

Post-Hospitalization Short-Term Oxygen Therapy: Use of a Clinical Management Pathway and Long-Term Follow-Up

Other Ways of Knowing

The effect of preexisting respiratory co-morbidities on burn outcomes

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