Exercise oxygen flow titration methods in COPD patients with respiratory failure

Background. A rating scale that takes into account heart rate, acidosis, consciousness, oxygenation, and respiratory rate (the HACOR score) has been used to predict noninvasive ventilation (NIV) failure in patients with chronic obstructive pulmonary disease (COPD). However, the HACOR score has not been used to predict NIV failure in non-COPD patients with acute-on-chronic respiratory failure. Methods. This study was performed in the respiratory intensive care unit of a teaching hospital. Data had been collected prospectively between June 2011 and January 2019. We enrolled non-COPD patients who received NIV due to acute-on-chronic respiratory failure, pH < 7.35, and PaCO2 >45 mmHg. NIV failure was defined as requiring intubation or dying during NIV. The HACOR score was determined at initiation and after 1-2, 12, and 24 h of NIV. Scores can range from 0 to 27, with higher scores indicating a higher risk of NIV failure. Results. A total of 148 patients were enrolled in the study, 52 with sleep apnea-hypopnea syndrome, 34 with chronic thoracic sequelae, 31 with bronchiectasis, 14 with chest wall deformity, 5 with obesity-hypoventilation syndrome, and 12 with other conditions. Of the patients, 19 (13%) experienced NIV failure. From initiation to 24 h of NIV, the HACOR scores of patients who experienced NIV failure were much higher than those of patients who received successful NIV. The area under the receiver operating characteristic curve was 0.69, 0.91, 0.91, and 0.94 when the HACOR score was tested at initiation and after 1-2, 12, and 24 h of NIV, respectively. To obtain the best sensitivity and specificity, the cutoff value at initiation was 7 with a sensitivity of 68% and a specificity of 61%. After 1-2 h of NIV, it was 5 with a sensitivity of 90% and a specificity of 85%. After 12 h of NIV, it was 4 with a sensitivity of 82% and a specificity of 91%. After 24 h of NIV, it was 2 with a sensitivity of 100% and a specificity of 76%. Conclusions. The HACOR score has high sensitivity and specificity for predicting NIV failure among non-COPD patients who receive NIV due to acute-on-chronic respiratory failure with respiratory acidosis.

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Nasal High Flow Use in COPD Patients with Hypercapnic Respiratory Failure: Treatment Algorithm & Review of the Literature

COPD Journal of Chronic Obstructive Pulmonary Disease ◽

10.1080/15412555.2020.1715361 ◽

2020 ◽

Vol 17 (1) ◽

pp. 101-111 ◽

Cited By ~ 2

Author(s):

Ioannis Pantazopoulos ◽

Zoi Daniil ◽

Melanie Moylan ◽

Konstantinos Gourgoulianis ◽

Athanasios Chalkias ◽

...

Keyword(s):

Respiratory Failure ◽

Treatment Algorithm ◽

High Flow ◽

Review Of The Literature ◽

Hypercapnic Respiratory Failure ◽

Failure Treatment ◽

Copd Patients

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The Severe Respiratory Insufficiency Questionnaire was valid for COPD patients with severe chronic respiratory failure

Journal of Clinical Epidemiology ◽

10.1016/j.jclinepi.2007.09.009 ◽

2008 ◽

Vol 61 (8) ◽

pp. 848-853 ◽

Cited By ~ 30

Author(s):

Wolfram Windisch ◽

Stephan Budweiser ◽

Frank Heinemann ◽

Michael Pfeifer ◽

Peter Rzehak

Keyword(s):

Respiratory Failure ◽

Respiratory Insufficiency ◽

Chronic Respiratory Failure ◽

Copd Patients

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The Analysis of Non-Invasive Positive Pressure Ventilation in Treating COPD Patients Accompanied with Chronic Respiratory Failure

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a3344 ◽

2019 ◽

Author(s):

T. Ma ◽

Y. Hu ◽

B. Yan

Keyword(s):

Respiratory Failure ◽

Positive Pressure Ventilation ◽

Chronic Respiratory Failure ◽

Positive Pressure ◽

Non Invasive ◽

Copd Patients

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Effectiveness of early rehabilitation on patients with chronic obstructive lung disease and acute respiratory failure in intensive care units: A case–control study

Chronic Respiratory Disease ◽

10.1177/1479973118820310 ◽

2019 ◽

Vol 16 ◽

pp. 147997311882031

Author(s):

Willy Chou ◽

Chih-Cheng Lai ◽

Kuo-Chen Cheng ◽

Kuo-Shu Yuan ◽

Chin-Ming Chen ◽

...

Keyword(s):

Intensive Care ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Intensive Care Units ◽

Case Control Study ◽

Case Control ◽

Early Rehabilitation ◽

Chronic Obstructive ◽

Copd Patients ◽

Control Study

The effect of early rehabilitation on the outcome of patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure (ARF) in intensive care units (ICUs) remains unclear. We examined the effect of early rehabilitation on the outcomes of COPD patients requiring mechanical ventilation (MV) in the ICU. This retrospective, observational, case–control study was conducted in a medical center with a 19-bed ICU. The records of all 105 ICU patients with COPD and ARF who required MV from January to December 2011 were examined. The outcomes (MV duration, rates of successful weaning and survival, lengths of ICU and hospital stays, and medical costs) were recorded and analyzed. During the study period, 35 patients with COPD underwent early rehabilitation in the ICU and 70 demographically and clinically matched patients with similar COPD stage, cause of intubation, type of respiratory failure, and levels of disease severity who had not undergone early rehabilitation in the ICU were selected as comparative controls. Multiple regression analysis showed that early rehabilitation was significantly negatively associated with MV duration. Early rehabilitation for COPD patients in the ICU with ARF shortened the duration of their MV.

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Right Heart Functional Changes in the Acute, Hypercapnic Exacerbations of COPD

BioMed Research International ◽

10.1155/2014/596051 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Claudio Terzano ◽

Sofia Romani ◽

Carlo Gaudio ◽

Francesco Pelliccia ◽

Mattia Serao ◽

...

Keyword(s):

Respiratory Failure ◽

Right Atrial ◽

Copd Exacerbation ◽

Blood Gas ◽

Right Heart ◽

Functional Changes ◽

Arterial Blood ◽

Copd Patients ◽

The Right ◽

Severe Copd

Objective. To investigate the correlation between respiratory failure and the pulmonary circulation. We focused on anatomical and functional changes of the right heart.Design. Clinical investigation.Methods. We evaluated 75 patients hospitalized in our respiratory ward for COPD exacerbation. All patients underwent transthoracic echocardiography and measurements of right heart chambers. Moreover all patients underwent blood tests, measurement of blood pressure, evaluation of body mass index (BMI), ECGs, pulmonary function tests, and the Saint George’s Respiratory Questionnaire (SGRQ).Results. Among 75 patients consecutively hospitalized, 56 patients with a COPD exacerbation were included in our study. We have emphasized the higher value of PAPs and the increased size of right atrial area in severe COPD patients. Significant correlation was observed between low values of PaO2and larger area of the right atrium. The measurement of TAPSE showed a right ventricular dysfunction in all patients but especially in severe COPD patients. We have obtained a significant correlation between TAPSE and arterial blood gas.Conclusions. In patients with chronic respiratory failure, blood gas parameters should be considered as negative prognostic factors of right heart failure. Respiratory failure shows a relationship with pulmonary hypertension and with the anatomy and function of the right heart sections.

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