Comorbidities and Subgroups of Patients Surviving Severe Acute Hypercapnic Respiratory Failure in the Intensive Care Unit
| Autor: | Katerina Espa-Cervena, Jean-Paul Janssens, Elise Dupuis-Lozeron, Laurent Brochard, Jean-Louis Pépin, Roselyne Merlet-Violet, Dan Adler, Hajo Müller |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Comorbidity Polysomnography 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine law.invention Pulmonary function testing Pulmonary Disease Chronic Obstructive Switzerland/epidemiology 0302 clinical medicine Chronic Obstructive/epidemiology/physiopathology law Prevalence Prospective Studies Survivors Lung ddc:616 Sleep Apnea Obstructive COPD medicine.diagnostic_test Respiration Respiratory Insufficiency/epidemiology/physiopathology/therapy Heart Respiratory Function Tests/statistics & numerical data Intensive care unit Respiratory Function Tests Obstructive/epidemiology/physiopathology Intensive Care Units Polysomnography/statistics & numerical data medicine.anatomical_structure Echocardiography Heart/physiopathology Artificial Female Respiratory Insufficiency Switzerland Pulmonary and Respiratory Medicine medicine.medical_specialty ddc:174.957 Sleep Apnea Heart Diseases Patient Readmission Pulmonary Disease Echocardiography/statistics & numerical data 03 medical and health sciences Intensive care medicine Humans Intensive care medicine Aged business.industry Editorials Lung/physiopathology medicine.disease Respiration Artificial Obstructive sleep apnea 030228 respiratory system Heart Diseases/epidemiology/physiopathology Emergency medicine Patient Readmission/statistics & numerical data business Follow-Up Studies |
| Zdroj: | American Journal of Respiratory and Critical Care Medicine, Vol. 196, No 2 (2017) pp. 200-207 |
| ISSN: | 1535-4970 1073-449X |
| DOI: | 10.1164/rccm.201608-1666oc |
| Popis: | No methodical assessment of the lung, cardiac, and sleep function of patients surviving an acute hypercapnic respiratory failure episode requiring admission to the intensive care unit (ICU) has been reported in the literature.To prospectively investigate the prevalence and impact of comorbidities in patients treated by mechanical ventilator support (invasive or noninvasive) for acute hypercapnic respiratory failure in the ICU.Seventy-eight consecutive patients admitted for an episode of acute hypercapnic respiratory failure underwent an assessment of lung, cardiac, and sleep function by pulmonary function tests, transthoracic echocardiography, and polysomnography 3 months after ICU discharge.Sixty-seven percent (52 of 78) of patients exhibited chronic obstructive pulmonary disease (COPD), although only 19 had been previously diagnosed. Patients without COPD were primarily obese. Prevalence of severe obstructive sleep apnea was 51% (95% confidence interval, 34-69) in patients with COPD and 81% (95% confidence interval, 54-96) in patients without COPD. Previously undiagnosed cardiac dysfunction with preserved ejection fraction was highly prevalent (44%), as was hypertension (67%). More than half of the population demonstrated at least three major comorbidities known to precipitate acute hypercapnic respiratory failure. Multimorbidity was associated with longer time to hospital discharge. Hospital readmission or death occurred in 46% of patients over an average of 3.5 months after discharge.Severe hypercapnic respiratory failure requiring ICU admission resulted primarily from COPD or obesity. Major comorbidities are highly prevalent in both cases and most often ignored. Surviving acute hypercapnic respiratory failure should be an opportunity to systematically evaluate lung, heart, and sleep functions to improve poor outcomes. Clinical trial registered with www.clinicaltrials.gov (NCT 02111876). |
| Databáze: | OpenAIRE |
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