COPD exacerbation: mortality prognosis factors in a respiratory care unit.

OBJECTIVE: The aim of our study was to investigate the mortality predictive factors after a severe exacerbations of COPD admitted to a Spanish respiratory intermediate care unit (IRCU). PATIENTS AND METHODS: Prospective observational 2 years study, where we included all episodes of acute exacerbations of COPD with hypercapnic respiratory failure admitted in an IRCU. We analyzed different sociodemographic, functional and clinical variables including physical activity. RESULTS: We collected data from 102 consecutive episodes admitted to IRCU (90.1% men). Mean age was 69.4±10.6. The mean APACHE II was 19.6±5.0 and 9.5% presented a failure of other non respiratory organ. Non invasive ventilation was applied in 75.3% of the episodes and this treatment failed in 11.6% of them. The duration of stay in the IRCU was 3.5±2.1 days and 8.0±5.3 days in the hospital. The hospital mortality rate was 6.9%, and another 12.7% after 90 days of discharged. In order to predict hospital mortality, multivariant statistics identified a model with AUC of 0.867, based in 3 variables: the number of previous year admission for COPD exacerbation (p=0,048), the respiratory rate after 2 hours of treatment in the IRCU (p=0.0484) and the severity of the disease established with ADO score (p=0.0241). CONCLUSIONS: The number of previous year admission for COPD exacerbation, the severity of the disease established with ADO score, the respiratory rate after 2 hours of treatment, allow us to identify what patients with a COPD exacerbation admitted in a IRCU can die during this episode.

Exacerbación de EPOC: factores predictores de mortalidad en una unidad de cuidados respiratorios intermedios / COPD Exacerbation: Mortality Prognosis Factors in a Respiratory Care Unit

ObjetivoDeterminar los factores predictores de mortalidad hospitalaria durante un ingreso por exacerbación de la enfermedad pulmonar obstructiva crónica (EPOC) en una unidad de cuidados respiratorios intermedios (UCRI).MetodologíaEstudio prospectivo observacional de 2 años de duración en el que se incluyeron todos los ingresos en una UCRI por exacerbación de la EPOC. Se analizaron diferentes variables sociodemográficas, funcionales, clínicas y la actividad física.ResultadosDurante este periodo evaluamos 102 episodios (90,1% varones), con una edad media de 69,4±10,6. El APACHE II (Acute Physiology and Chronic Health Evaluation Score) fue de 19,6±5,0 y el 9,5% presentaban fallo de otro órgano no respiratorio. El 75,3% recibieron ventilación mecánica no invasiva y esta fracasó en el 11,6% de ellos. La duración de la estancia en la UCRI y en el hospital fue de 3,5±2,1 y 8,0±5,3 días, respectivamente. La mortalidad durante el episodio de hospitalización fue de 6,9% y un 12,7% a los 90 días del alta hospitalaria. El análisis multivariante identificó un modelo predictivo con un estadístico C de 0,867, basado en el número de ingresos por exacerbación durante el año previo (p=0,048), la frecuencia respiratoria (FR) a las 2 horas del ingreso en la UCRI (p=0,048) y la puntuación obtenida en la escala multidimensional ADO (p=0,024).ConclusionesEl número de ingresos por exacerbación de la EPOC durante el año previo, la FR a las 2 horas del ingreso en la UCRI y la escala multidimensional ADO nos permitirían identificar los pacientes susceptibles de fallecer durante un ingreso por descompensación de la EPOC en la UCRI(AU)

ObjectiveThe aim of our study was to investigate the mortality predictive factors after a severe exacerbations of COPD admitted to a Spanish respiratory intermediate care unit (IRCU).Patients and methodsProspective observational 2 years study, where we included all episodes of acute exacerbations of COPD with hypercapnic respiratory failure admitted in an IRCU. We analyzed different sociodemographic, functional and clinical variables including physical activity.ResultsWe collected data from 102 consecutive episodes admitted to IRCU (90.1% men). Mean age was 69.4±10.6. The mean APACHE II was 19.6±5.0 and 9.5% presented a failure of other non respiratory organ. Non invasive ventilation was applied in 75.3% of the episodes and this treatment failed in 11.6% of them. The duration of stay in the IRCU was 3.5±2.1 days and 8.0±5.3 days in the hospital. The hospital mortality rate was 6.9%, and another 12.7% after 90 days of discharged. In order to predict hospital mortality, multivariant statistics identified a model with AUC of 0.867, based in 3 variables: the number of previous year admission for COPD exacerbation (p=0,048), the respiratory rate after 2hours of treatment in the IRCU (p=0.0484) and the severity of the disease established with ADO score (p=0.0241).ConclusionsThe number of previous year admission for COPD exacerbation, the severity of the disease established with ADO score, the respiratory rate after 2hours of treatment, allow us to identified what patients with a COPD exacerbation admitted in a IRCU can die during this episode(AU)

Cuidados respiratorios intermedios: un año de experiencia / A Year's Experience in an Intermediate Respiratory Care Unit

IntroducciónEl objetivo del presente estudio es describir las características y resultados de los pacientes ingresados en una unidad de cuidados respiratorios intermedios (UCRI).Pacientes y métodosSe ha realizado un estudio prospectivo y observacional de un año de duración, en el que se estudió a todos los pacientes ingresados en nuestra UCRI durante ese período. Se analizaron variables sociodemográficas, clínicas, escala APACHE-II, evolución gasométrica, duración de la estancia hospitalaria, mortalidad y reingreso hospitalario.ResultadosEvaluamos a 190 pacientes (un 64,2% varones), con una edad media de 69,4 años. El 43,2% tenía un índice de Charlson mayor de 2. El APACHE-II fue de 16,3 en el Servicio de Urgencias y de 14,3 al entrar en la UCRI. El 50% de los pacientes ingresó para recibir ventilación, y de ellos sólo 6 (5,7%) ingresaron para la desconexión del ventilador. La duración media de la estancia en la UCRI fue de 3,7 días. La tasa de reingresos fue del 12,7%. La mortalidad fue del 12,6% durante el episodio de hospitalización, y del 11,6% a los 90 días del alta.ConclusionesLos ingresados en nuestra UCRI son pacientes mayores, con importante comorbilidad y mortalidad elevada, tanto durante el episodio de hospitalización como a los 90 días del alta hospitalaria. No hemos encontrado diferencias estadísticamente significativas en los resultados (estancia media, reingresos, mortalidad) en función del tipo de cuidados (ventilación frente a seguimiento) administrados al paciente(AU)

BackgroundThe aim of this study was to describe the characteristics and results of patients admitted to an intermediate respiratory care unit (IRCU).Patients and MethodsWe performed a 12-month prospective observational study of all the patients admitted to our IRCU during the study period. We analyzed sociodemographic and clinical variables, the APACHE-II score, blood gas parameters, duration of stay in hospital, mortality, and readmission to hospital.ResultsWe evaluated 190 patients (64.2% men), with a mean age of 69.4 years. A score of greater than 2 on the Charlson index was recorded in 43.2% of patients. The mean APACHE-II score was 16.3 in the emergency department and 14.3 on entering the IRCU. Fifty percent of the patients were admitted to receive ventilation and, of these, only 6 (5.7%) were admitted for disconnection of the ventilator. The mean duration of stay in the IRCU was 3.7 days. The readmission rate was 12.7% Mortality was 12.6% during hospitalization and 11.6% 90 days after discharge.ConclusionsThe patients admitted to our IRCU were elderly, with considerable comorbidity and high mortality, both during hospitalization and 90 days after discharge from hospital. The results revealed no statistically significant differences (mean length of stay, readmission, mortality) according to the type of care administered to the patients (ventilation compared to monitoring(AU)

[A year's experience in an intermediate respiratory care unit]. / Cuidados respiratorios intermedios: un año de experiencia.

BACKGROUND: The aim of this study was to describe the characteristics and results of patients admitted to an intermediate respiratory care unit (IRCU). PATIENTS AND METHODS: We performed a 12-month prospective observational study of all the patients admitted to our IRCU during the study period. We analyzed sociodemographic and clinical variables, the APACHE-II score, blood gas parameters, duration of stay in hospital, mortality, and readmission to hospital. RESULTS: We evaluated 190 patients (64.2% men), with a mean age of 69.4 years. A score of greater than 2 on the Charlson index was recorded in 43.2% of patients. The mean APACHE-II score was 16.3 in the emergency department and 14.3 on entering the IRCU. Fifty percent of the patients were admitted to receive ventilation and, of these, only 6 (5.7%) were admitted for disconnection of the ventilator. The mean duration of stay in the IRCU was 3.7 days. The readmission rate was 12.7% Mortality was 12.6% during hospitalization and 11.6% 90 days after discharge. CONCLUSIONS: The patients admitted to our IRCU were elderly, with considerable comorbidity and high mortality, both during hospitalization and 90 days after discharge from hospital. The results revealed no statistically significant differences (mean length of stay, readmission, mortality) according to the type of care administered to the patients (ventilation compared to monitoring).