Predictors of Successful Oxygen Weaning in Older Patients Undergoing Pulmonary Rehabilitation.

OBJECTIVES: To identify clinical and/or functional variables predictive of successful oxygen-weaning among older patients affected by respiratory insufficiency undergoing pulmonary rehabilitation. DESIGN: Retrospective study. SETTING AND PARTICIPANTS: Data are from 154 patients aged 65 years and older (mean age = 78.1 years; female 50.6%) admitted to a pulmonary rehabilitation unit to follow an in-patient program. Patients must require oxygen therapy at admission. METHODS: All patients performed the 6-Minute Walking Test at admission and before discharge as well as a spirometry at a steady state. Multivariate logistic regressions were performed to identify positive and negative predictors of successful oxygen weaning. RESULTS: Successful oxygen weaning was obtained in 47 participants (30.5%). The restrictive pattern was associated with a 4-fold likelihood of successful oxygen weaning at the end of the rehabilitation program compared with the obstructive one. A positive association was also found for arterial oxygenation index (PaO2/FiO2 ratio) at baseline. A decreased likelihood of successful oxygen weaning was reported for the subjective dyspnea perception score at exertion evaluated with a modified Borg scale. CONCLUSIONS AND IMPLICATIONS: The restrictive pattern, PaO2/FiO2 ratio, and modified Borg dyspnea scale score under exertion were significantly associated with successful oxygen-weaning. The identified predictors may support clinicians at precociously identifying patients who may not require oxygen therapy after discharge. Therefore, these findings would make it possible for clinicians to better tailor the rehabilitation program.

Developing a Frailty Index from routinely collected data in the Emergency Department among of hospitalized patients.

PURPOSE: The number of frail patients admitted to Emergency Departments is increasing. The so-called Frailty Index based on the age-related accumulation of deficits models is often perceived as excessively burdening or not feasible in busy clinical settings due to its quantitative nature. We wanted to prove the possibility of generating a Frailty Index in the Emergency Department from data that are routinely collected during the standard clinical practice in this setting and to test its predictive capacity for adverse events. METHODS: A retrospective analysis of the medical records of 110 hospitalized patients (mean age = 67.4 ± 18.9 years; women 41.8%) admitted to our Emergency Department during 6 days of 2017. A 41-item Frailty Index was computed from vital signs, physical examination, anamnestic diseases, and blood tests routinely collected by Emergency Department physicians. The length of the subsequent hospital stay and the institutionalization of the patient at the hospital discharge were the dependent variables of interest. RESULTS: Median length of stay was 11.0 (interquartile range, IQR = 6.0-16.0) days. Institutionalization rate at discharge was 18.2%. The median Frailty Index was 0.22 (IQR = 0.17-0.30). The Frailty Index was significantly correlated with age (Spearman's r = 0.44, p < 0.001) and resulted significantly associated with length of stay and institutionalization. The receiver operating characteristics areas under the curve were 0.731 (Confidence Interval, 95%CI 0.601-0.860, p = 0.001) and 0.726 (95%CI 0.610-0.841, p < 0.001) in the prediction of institutionalization and prolonged hospital stay, respectively. No statistically significant association of age with a length of stay (p = 0.75) nor institutionalization (p = 0.09) was reported. CONCLUSIONS: The standard multidimensional assessment conducted at the Emergency Department admission has all the necessary features to generate a meaningful clinical Frailty Index, potentially supporting decisions since the first contact of the individual with the hospital system.