Clinical characteristics, management in real world practice and long-term survival among COPD patients of Northern Thailand COPD club members.

OBJECTIVE: To assess the baseline clinical characteristics, management, and long-term survival of hospital-based COPD patients in the northern part of Thailand. MATERIAL AND METHOD: One hundred and ninety five hospital-based COPD patients from community and provincial hospitals in the northern part of Thailand were recruited between May and November 2002. They were followed up for 45 months for survival. RESULTS: Most of them (71.3%) were in the advanced stage and 41.8% were undernourished. Only a small fraction of the advanced stage patients (25.7%) estimated their dyspnea severity correctly with the disease stages. The frequency of the exacerbations increases as the disease become more severe. Only 23.7% of the advanced stage patients had received regular bronchodilator therapy. No patients had received pulmonary rehabilitation and long-term oxygen therapy. The 45 months survival was 75.6% in all patients. The severe group with low BMI had significantly lower survival than the one with normal BMI (67.7% vs. 89.8%, p = 0.040). CONCLUSION: Most COPD patients in the northern part of Thailand were in the advanced stage. They were commonly undernourished and exacerbated but still under treated according to standard treatment guidelines. BMI tends to influence the long-term survival of the advanced stage patients.

Efficacy of weaning protocol in medical intensive care unit of tertiary care center.

OBJECTIVE: To evaluate the efficacy of the protocol-directed weaning from a mechanical ventilator compared to physician-directed weaning. MATERIAL AND METHOD: A comparative study between retrospective studies of physician-directed weaning as controls (N = 198) reviewed from July 2000 to July 2002 and the prospective studies of protocol-directed weaning as intervention (N = 196) enrolled from October 2002 to October 2003 in the medical ICU of Maharaj Nakorn Chiang Mai Hospital, tertiary care center of northern Thailand. Study results were concluded by Fisher's exact test. RESULTS: Baseline characteristics data of both groups including sex, age, illness severity which demonstrated by APACHE II score and PaO2/FiO2 ratio, causes of respiratory failure and mode of mechanical ventilation used were similar. The duration of mechanical ventilation before weaning was 5.89 +/- 3.71 days in the protocol-directed group and 7.41 +/- 5.54 days in the physician-directed group (p < 0.05). Weaning duration in the protocol-directed group was significantly shorter than the physician-directed group (14.58 +/- 16. 98 hours VS 47.09 +/- 38.23 hours; p < 0.05). Kaplan-Meire analysis demonstrated that patients in the protocol-directed group had significantly shorter durations of mechanical ventilation compared to patients in the physician-directed group (p = 0.001, log-rank test). The ICU LOS was significantly shorter in the protocol-directed group (7.91 +/- 4.71 vs 11.53 +/- 7.80 days; p < 0.05). The 28 days mortality rate and the incidence of hospital acquired pneumonia seemed to be less in the protocol-directed group (4.60% vs 6.10% and 5.60% vs 10.10% consecutively) and reintubation rate seemed to be higher in the protocol-directed group (6.1% vs 4.5%) than the physician-directed group but differences were not significant (p > 0. 05). CONCLUSION: Protocol-directed weaning proved to have more efficacy in weaning patients from a ventilator than physician-directed weaning in terms of weaning duration and ICU length of stay without a deteriorating effect to the patients.