scholarly journals Impact of a Positive Viral Polymerase Chain Reaction on Outcomes of Chronic Obstructive Pulmonary Disease (COPD) Exacerbations

2020 ◽  
Vol 17 (21) ◽  
pp. 8072 ◽  
Author(s):  
Kulothungan Gunasekaran ◽  
Mudassar Ahmad ◽  
Sana Rehman ◽  
Bright Thilagar ◽  
Kavitha Gopalratnam ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Length Of Stay ◽  
Pulmonary Disease ◽  
Respiratory Virus ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
The Mean

Introduction: More than 15 million adults in the USA have chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease (COPD) places a high burden on the healthcare system. Many hospital admissions are due to an exacerbation, which is suspected to be from a viral cause. The purpose of this analysis was to compare the outcomes of patients with a positive and negative respiratory virus panel who were admitted to the hospital with COPD exacerbations. Methods: This retrospective cohort study was conducted in the Geisinger Healthcare System. The dataset included 2729 patient encounters between 1 January 2006 and 30 November 2017. Hospital length of stay was calculated as the discrete number of calendar days a patient was in the hospital. Patient encounters with a positive and negative respiratory virus panel were compared using Pearson’s chi-square or Fisher’s exact test for categorical variables and Student’s t-test or Wilcoxon rank-sum tests for continuous variables. Results: There were 1626 patients with a total of 2729 chronic obstructive pulmonary disease exacerbation encounters. Nineteen percent of those encounters (n = 524) had a respiratory virus panel performed during their admission. Among these encounters, 161 (30.7%) had positive results, and 363 (69.3%) had negative results. For encounters with the respiratory virus panel, the mean age was 64.5, 59.5% were female, 98.9% were white, and the mean body mass index was 26.6. Those with a negative respiratory virus panel had a higher median white blood cell count (11.1 vs. 9.9, p = 0.0076). There were no other statistically significant differences in characteristics between the two groups. Respiratory virus panel positive patients had a statistically significant longer hospital length of stay. There were no significant differences with respect to being on mechanical ventilation or ventilation-free days. Conclusion: This study shows that a positive respiratory virus panel is associated with increased length of hospital stay. Early diagnosis of chronic obstructive pulmonary disease exacerbation patients with positive viral panel would help identify patients with a longer length of stay.

A nationwide analysis on the effects of chronic obstructive pulmonary disease following primary total shoulder arthroplasty for glenohumeral osteoarthritis

2021 ◽  
pp. 175857322199382
Author(s):  
Brandon Amirian ◽  
Kyrillos M Akhnoukh ◽  
Asad M Ashraf ◽  
Samuel J Swiggett ◽  
Francis E Rosato ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Length Of Stay ◽  
Pulmonary Disease ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Medical Complications ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Background Chronic obstructive pulmonary disease patients have been shown in orthopedic literature to have poorer outcomes and higher rates of complications from surgery. In this retrospective review, medical complications, length of stay, and costs were obtained to explore the effects of chronic obstructive pulmonary disease on patients undergoing primary total shoulder arthroplasty. Methods Total shoulder arthroplasty cases from January 2005 to March 2014 were queried and analyzed from a nationwide database. Study patients were matched 1:5 to controls by age, sex, and medical comorbidities associated with chronic obstructive pulmonary disease. In-hospital length of stay, 90-day medical complications, day of surgery, and total global 90-day episode of care costs were obtained for comparison. Results Chronic obstructive pulmonary disease patients were found to have higher incidence and odds (53.91 vs. 11.95%; OR: 3.58, 95%CI: 3.18–3.92, p < 0.0001) of 90-day medical complications, longer in-hospital length of stay (3 vs. 2 days, p < 0.0001), and significantly higher 90-day costs ($14,768.37 vs. $13,379.20, p < 0.0001) following primary total shoulder arthroplasty compared to matched controls. Discussion Chronic obstructive pulmonary disease patients undergoing primary total shoulder arthroplasty have higher rates of medical complications, in-hospital length of stay, and costs of care. This represents an important factor that will allow orthopedic surgeons to adequately manage expectations and educate chronic obstructive pulmonary disease patients of the potential complications which may occur following total shoulder arthroplasty.

scholarly journals Impact of Air Pollution and Outdoor Temperature on the Rate of Chronic Obstructive Pulmonary Disease Exacerbations

Folia Medica ◽  
2017 ◽  
Vol 59 (4) ◽  
pp. 423-429 ◽  
Author(s):  
Iliya I. Krachunov ◽  
Nikolay H. Kyuchukov ◽  
Zlatina I. Ivanova ◽  
Nikolay A. Yanev ◽  
Petkana A. Hristova ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Air Pollution ◽  
Pulmonary Disease ◽  
Air Pollutants ◽  
Chronic Obstructive ◽  
Outdoor Temperature ◽  
Obstructive Pulmonary Disease ◽  
Daily Number ◽  
Copd Exacerbations ◽  
The Mean

AbstractBackground: Environmental pollution can be one of the main risk factors for acute exacerbations of chronic obstructive pulmonary disease (COPD). Aim: To study the relationship between air pollution, outdoor temperature and exacerbations of COPD. Materials and methods: COPD patients (n=1432) were followed up for one year. The levels of particulate matter up to 10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2) and outside temperatures were collected from the Environmental Agency database. Results: A total of 309 acute COPD exacerbations (AECOPD) were recorded in the analysis. The daily mean concentrations of PM10were found to correlate significantly with the daily mean concentrations of NO2and SO2(ρ 0.34 and ρ 0.49, respectively; p=0.0001). The negative correlations between the daily mean temperature and the daily mean levels of PM10, NO2and SO2were also significant (ρ -0.44, ρ -0.11, and ρ -0.37, respectively; p=0.0001). The daily number of AECOPD correlated with the mean levels of PM10in the previous six days (ρ 0.14; p=0.02) and the lower outdoor temperature (ρ -0.2; p=0.001). The negative correlation between the daily number of AECOPD and the mean daily temperature was stronger in days with levels of PM10above 50 μg/m3(ρ -0.3 p=0.02 vs. ρ -0.18 p= 0.01). Conclusion: Lower daily mean temperatures were associated with the levels of air pollutants. The level of PM10correlated with the levels of the other air pollutants. The daily number of AECOPD was found to correlate weakly, but signifi cantly with the mean level of PM10in the previous six days.

The Mater Hospital Multiprofessional Care Pathway for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

2005 ◽  
Vol 9 (1) ◽  
pp. 32-36 ◽  
Author(s):  
Terence E McManus ◽  
Anne-Marie Marley ◽  
Joseph C Kidney
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Length Of Stay ◽  
Pulmonary Disease ◽  
Care Pathway ◽  
Multidisciplinary Care ◽  
Chronic Obstructive ◽  
Readmission Rates ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbations ◽  
The Mean

Introduction: Chronic obstructive pulmonary disease (COPD) is a common condition associated with an increasing mortality and morbidity. There are also significant economic implications with hospital admission accounting for the majority of the total COPD health care expenditure. Mild exacerbations of COPD can be treated at home; severe exacerbations require hospitalization. The purpose of this programme of care was to integrate and optimize treatment using current guidelines. Methods: This was a prospective study of management of severe exacerbations of COPD following implementation of a structured care pathway. The project was based at a district general hospital in inner city Belfast. Key measures of improvement were length of hospital stay, readmission rates within one month and hospital mortality. A multidisciplinary care pathway incorporated a score that was developed with one point for each of the following markers of a severe exacerbation: dyspnoea at rest, bed bound, tachypnoea (>25), tachycardia (>110), pyrexia (>38.5), use of accessory muscles of respiration and peripheral oedema. We have called this the ‘Mater COPD score’. The aim was for optimal management, education and identification of appropriate time for discharge. Patient treatment was standardized using oral steroid therapy, nebulized bronchodilators (air cylinders were used to provided nebulization where appropriate) and antibiotic therapy. Results: A total of 85 patients were studied, 40 men with a mean (SEM) age of 68.6 (1.7) years. The mean COPD score on admission was 2.3 (range 0–6). Mean score on discharge was 0.4 (range 0–3). Mean forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were 0.97 and 1.83 L, respectively. Seven patients were readmitted within one month. The mean length of an episode was reduced from 9.4 to 5.5 days, with a national average of 9.7 days at that time. However, delayed discharge in 25 cases (due to co-morbidity, social problems or other factors) resulted in the overall length of stay being reduced to 6.5 days. Continued follow-up using this pathway reduced the length of stay of all admissions with COPD by four days to 5.4 days. Nebulizers were routinely changed from oxygen driven to air driven. There was a 1700% increase in air cylinders used over the two years following introduction. This was associated with a 57% reduction in mortality. Conclusions: A multidisciplinary care pathway in the management of acute exacerbations of COPD ensures optimal treatment for patients and results in a significant reduction in the length of stay and a reduced mortality rate without increasing readmission rates.

Invasive-noninvasive Sequential Ventilation for the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease

2019 ◽  
Vol 22 (3) ◽  
pp. 160-168
Author(s):  
Jian-Da Huang ◽  
Tong-Jie Gu ◽  
Zhi-Lin Hu ◽  
Dan-Fei Zhou ◽  
Jun Ying
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Length Of Stay ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Relevant Literature ◽  
Total Duration ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Relative Risks

Background: The study aimed to evaluate the efficacy and safety of invasivenoninvasive sequential ventilation versus invasive ventilation in the treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Method: PubMed, Cochrane, Embase, Wanfang, CNKI, VIP database were searched by the index words to identify the qualified RCTs, and relevant literature sources were also searched. The latest research was conducted in June 2017. Relative Risks (RR), and Mean Difference (MD) along with 95% confidence interval (95% CI) were used to analyze the main outcomes. Result: Twenty-nine RCTs were involved in this analysis of 1061 patients in the invasivenoninvasive sequential ventilation group (In-non group) and 1074 patients in the invasive ventilation group (In group). The results indicated that compared with the invasive ventilation, invasive-noninvasive sequential ventilation would significantly decrease the incidence of VAP (RR:0.20, 95%CI: 0.16-0.26), mortality (RR:0.38, 95%CI: 0.26-0.55), reintubation (RR:0.39, 95%CI: 0.27-0.55); and statistically reduced the duration of invasive ventilation (MD:-9.23, 95%CI: -10.65, -7.82), the total duration of mechanical ventilation (MD:-4.91, 95%CI: -5.99, -3.83), and the length of stay in the ICU (MD:-5.10, 95%CI: -5.43, -4.76). Conclusion: The results demonstrated that the application of noninvasive sequential ventilation after invasive ventilation at the pulmonary infection control window has a significant influence on VAP incidence, mortality, and the length of stay in the ICU, but further well-designed, adequately powered RCTs are required to validate the conclusion.

scholarly journals COVID-19 health inequities and association with mechanical ventilation and prolonged length of stay at an urban safety-net health system in Chicago

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258243
Author(s):  
Jacquelyn Jacobs ◽  
Amy K. Johnson ◽  
Arianna Boshara ◽  
Bijou Hunt ◽  
Christina Khouri ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Pulmonary Disease ◽  
Safety Net ◽  
Chronic Obstructive ◽  
Minority Population ◽  
Obstructive Pulmonary Disease ◽  
Ethnic Minority Population ◽  
Prolonged Length

Millions of Americans have been infected with COVID-19 and communities of color have been disproportionately burdened. We investigated the relationship between demographic characteristics and COVID-19 positivity, and comorbidities and severe COVID-19 illness (use of mechanical ventilation and length of stay) within a racial/ethnic minority population. Patients tested for COVID-19 between March 2020 and January 2021 (N = 14171) were 49.9% (n = 7072) female; 50.1% (n = 7104) non-Hispanic Black; 33.2% (n = 4698) Hispanic; and 23.6% (n = 3348) aged 65+. Overall COVID-19 positivity was 16.1% (n = 2286). Compared to females, males were 1.1 times more likely to test positive (p = 0.014). Compared to non-Hispanic Whites, non-Hispanic Black and Hispanic persons were 1.4 (p = 0.003) and 2.4 (p<0.001) times more likely, respectively, to test positive. Compared to persons ages 18–24, the odds of testing positive were statistically significantly higher for every age group except 25–34, and those aged 65+ were 2.8 times more likely to test positive (p<0.001). Adjusted for race, sex, and age, COVID-positive patients with chronic obstructive pulmonary disease were 1.9 times more likely to require a ventilator compared to those without chronic obstructive pulmonary disease (p = 0.001). Length of stay was not statistically significantly associated with any of the comorbidity variables. Our findings emphasize the importance of documenting COVID-19 disparities in marginalized populations.

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