Serum Troponin-I as a prognostic marker in acute exacerbated chronic obstructive pulmonary disease patients

Background: Chronic Obstructive Pulmonary Disease [COPD] is a major cause of chronic morbidity and mortality worldwide. It is the fifth leading cause of death worldwide. The spectrum of cardiovascular complications associated with COPD is clearly broad, right ventricular [RV] dysfunction and pulmonary vascular disease are common in COPD and progress with time. In RV failure, cardiac Troponins [cTn] are suspected to be elevated secondary to RV ischemia or micro infarction

Objective: To evaluate the prognostic value of cardiac Troponin I level in acute exacerbated chronic obstructive pulmonary diseases [AECOPD] and its impact on the hospital outcome in those patients

Patients and methods: This study was performed on 60 patients with AECOPD, admitted at Chest Department and respiratory ICU; Zagazig University hospital. All patients were subjected to: thorough history taking, clinical examination, electrocardiography and echocardiography, arterial blood gas [ABG] analysis, measure forced vital capacity [FVC] and forced expiratory volume in first second [FEV1], serum assay of cTnI level which is considered -ve if <0.01 ng/ml and +ve if >/=0.01 ng/ml

Results: cTnI was positive in 42 AECOPD patients. cTnI positivity was more prominent among patients with very severe exacerbation of COPD and in those with past history of LTOT, MV, ICU admission. Also, cTnI positivity was more in patients admitted to ICU rather than those managed in the ward and among patients who needed MV rather than who did not need it and in patients who failed weaned rather that who succeeded weaned. P-pulmonate, Rt. ventricular strain, high pulmonary artery pressure, hypoxemia and hypercapnia showed a great effect upon cTnI positivity. The duration of hospitalization was longer among cTnI +ve patients than cTnI ?ve ones, Tropinin cutoff value for the prediction of death was >0.055 ng/ml with Sensitivity = 75%, Specificity = 68%

Conclusion: Positive cTnI in AECOPD patients may suggest exacerbation severity and the occurrence of pulmonary hypertension and right ventricular dysfunction. Positive cTnI is considered as good prognostic marker for the possibility of a need for MV and a longer duration of hospitalization. MV may further elevate cTnI in AECOPD patients and with possible weaning failure. Negative cTnI and cTnI

Role of rehabilitation of chronic obstructive pulmonary disease patients in intensive care unit

The COPD are the most common chronic lung disease and the major impetus for the development of pulmonary rehabilitation program. Poor endurance, dyspnea, and deconditioning are the hallmarks of the presenting symptoms. The key components of pulmonary rehabilitation are education, exercise training, psychosocial/behavioral intervention and outcome assessment. The present study was designed to study the effects of pulmonary rehabilitation on patient of COPD and compare between comprehensive rehabilitation program and progressive ambulation as regard some physiologic variables. This study included eighty COPD patients recovering from an episode of acute respiratory failure and admitted to RICU of Zagazig University Hospital. All of them fulfilled the American Thoracic Society criteria of COPD 1995, with the age ranging from 51 to 80 years. Evaluating measures were done as early as possible at admission, discharge and after 3 months and they include: arterial blood gases [ABG], pulmonary ventilatory tests [PVT], maximal inspiratory pressure [MIP], visual analog scale [VAS] and 6 min walking distance [6 m WD]. Rehabilitation program were usually begun as early as possible for clinically stable patients, it consists of daily session 30-45 min for each and of four different steps of increasing difficulty. Our results showed that pulmonary rehabilitation is of great beneficial effects for critically ill COPD patients admitted to RICU and early intervention give better results. Also comprehensive program was superior to ambulation program