Gait speed is associated with death or readmission among patients surviving acute hypercapnic respiratory failure

ObjectivesDeath or hospital readmission are frequent among patients surviving acute hypercapnic respiratory failure (AHRF). Severity scores are not valid to predict death or readmission after AHRF. Gait speed, a simple functional parameter, has been associated with hospital admission and death in the general population. The purpose of this study is to highlight an association between gait speed at hospital discharge and death or readmission among AHRF survivors.DesignSecondary analysis of a prospective cohort study.SettingsSingle Swiss tertiary hospital, pulmonary division.ParticipantsPatients were prospectively recruited to form a cohort of patients surviving AHRF in the intensive care unit between January 2012 and May 2015.Outcome measureGait speed was derived from a 6 min walking test (6MWT) before hospital discharge. All predictive variables were prospectively collected. Death or hospital readmission were recorded for 6 months. Univariate and multivariate analyses were performed to evaluate the association between predictive variables and death or hospital readmission.Results71 patients performed a 6MWT. 34/71 (48%) patients died or were readmitted to the hospital during the observation period. Median gait speed was 0.7 (IQR 0.3–1.0) m/s. At 6 months, 66% (25/38) of slow walkers (gait speed <0.7 m/s) and 27% (9/33) of non-slow walkers died or were readmitted to the hospital (p=0.002). In univariate analysis, gait speed was associated with death or readmission (HR 0.41; 95% CI 0.19 to 0.90, p=0.025). In a multivariate model adjusted for age, gender, body mass index, forced expired volume, heart failure and home mechanical ventilation, gait speed remained the only variable associated with death or readmission (multivariate HR: 0.35; 95% CI 0.14 to 0.88, p=0.025).ConclusionThis study suggests that a simple functional parameter such as gait speed is associated with death or hospital readmission in patients surviving AHRF.Trial registration numberNCT02111876.

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Ward-Based Noninvasive Ventilation for Acute Hypercapnic Respiratory Failure Unrelated to Chronic Obstructive Pulmonary Disease

Canadian Respiratory Journal ◽

10.1155/2021/4835536 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Bandar M. Faqihi ◽

Dhruv Parekh ◽

Samuel P. Trethewey ◽

Julien Morlet ◽

Rahul Mukherjee ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Respiratory Failure ◽

Hospital Mortality ◽

Pulmonary Disease ◽

Hospital Discharge ◽

Noninvasive Ventilation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Hypercapnic Respiratory Failure ◽

Acute Hypercapnic Respiratory Failure

Background. The use of ward-based noninvasive ventilation (NIV) for acute hypercapnic respiratory failure (AHRF) unrelated to chronic obstructive pulmonary disease (COPD) remains controversial. This study evaluated the outcomes and failure rates associated with NIV application in the ward-based setting for patients with AHRF unrelated to COPD. Methods. A multicentre, retrospective cohort study of patients with AHRF unrelated to COPD was conducted. COPD was not the main reason for hospital admission, treated with ward-based NIV between February 2004 and December 2018. All AHRF patients were eligible; exclusion criteria comprised COPD patients, age < 18 years, pre-NIV pH < 7.35, or a lack of pre-NIV blood gas. In-hospital mortality was the primary outcome; univariable and multivariable models were constructed. The obesity-related AHRF group included patients with AHRF due to obesity hypoventilation syndrome (OHS), and the non-obesity-related AHRF group included patients with AHRF due to pneumonia, bronchiectasis, neuromuscular disease, or fluid overload. Results. In total, 479 patients were included in the analysis; 80.2% of patients survived to hospital discharge. Obesity-related AHRF was the indication for NIV in 39.2% of all episodes and was the aetiology with the highest rate of survival to hospital discharge (93.1%). In the multivariable analysis, factors associated with a higher risk of in-hospital mortality were increased age (odds ratio, 95% CI: 1.034, 1.017–1.051, P < 0.001 ) and pneumonia on admission (5.313, 2.326–12.131, P < 0.001 ). In the obesity-related AHRF group, pre-NIV pH < 7.15 was associated with significantly increased in-hospital mortality (7.800, 1.843–33.013, P = 0.005 ); however, a pre-NIV pH 7.15–7.25 was not associated with increased in-hospital mortality (2.035, 0.523–7.915, P = 0.305 ). Conclusion. Pre-NIV pH and age have been identified as important predictors of surviving ward-based NIV treatment. Moreover, these data support the use of NIV in ward-based settings for obesity-related AHRF patients with pre-NIV pH thresholds down to 7.15. However, future controlled trials are required to confirm the effectiveness of NIV use outside critical care settings for obesity-related AHRF.

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Comorbidities and Readmissions in Survivors of Acute Hypercapnic Respiratory Failure

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0040-1710074 ◽

2020 ◽

Vol 41 (06) ◽

pp. 806-816 ◽

Cited By ~ 1

Author(s):

Dan Adler ◽

Giulia Cavalot ◽

Laurent Brochard

Keyword(s):

Respiratory Failure ◽

Hospital Readmission ◽

Airflow Obstruction ◽

Holistic Approach ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Hypercapnic Respiratory Failure ◽

Icu Admission ◽

Related Quality ◽

Acute Hypercapnic Respiratory Failure

AbstractChronic obstructive pulmonary disease (COPD) is defined by chronic airflow obstruction, but is presently considered as a complex, heterogeneous, and multicomponent disease in which comorbidities and extrapulmonary manifestations make important contributions to disease expression. COPD-related hospital readmission. In particular frequent intensive care unit (ICU) readmissions for exacerbations represent a major challenge and place a high burden on patient outcomes and health-related quality of life, as well as on the healthcare system.In this narrative review, we first address major and often undiagnosed comorbidities associated with COPD that could have an impact on hospital readmission after an index ICU admission for acute hypercapnic respiratory failure. Some guidance for treatment is discussed. Second, we present predictors of hospital and ICU readmission and discuss various strategies to reduce such events.There is a strong rationale to detect and treat major comorbidities early after index ICU admission for acute hypercapnic respiratory failure. It still remains unclear, however, if a comprehensive and holistic approach to comorbidities in frail patients surviving hypercapnic respiratory failure can efficiently reduce the readmission rate.

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