| Hypercapnic respiratory failure in COPD patients: response to therapy. | |
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MedLine Citation:
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PMID: 10631216 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: The clinical course of patients with acute exacerbations of underlying COPD presenting with hypercapnic respiratory failure was reviewed. METHODS: This was a retrospective review of 138 episodes of hypercapnic respiratory failure (PaCO(2) > or = 50 mm Hg and pH < or = 7.35). Patients were admitted to the West Los Angeles VAMC Medical Intensive Care Unit between 1990 and 1994. RESULTS: Of the 138 hypercapnic episodes, 74 (54%) required intubation. Comparison was made with the 64 cases in which patients responded to medical therapy. Patients requiring intubation had a greater severity of illness, with a higher APACHE II (Acute Physiology and Chronic Health Evaluation II) score (18 +/- 5 vs 16 +/- 4; p < 0.01), higher WBC, higher serum BUN, and greater acidosis (pH, 7.26 +/- 0.07 vs 7.28 +/- 0.06; p = 0.08). Those with the most severe acidosis (pH < 7.20) had the highest intubation rate (70%) and shortest time to intubation (2 +/- 2 h), and they required the longest period of time to respond to medical therapy (69 +/- 60 h). With an initial pH of < 7.25, there was a consistently higher intubation rate. Conversely, those with an initial pH of 7.31 to 7. 35 were less likely to be intubated (45%), had a longer time to intubation (13 +/- 18 h), and had a more rapid response to medical therapy (30 +/- 18 h). Of those patients requiring intubation, most (78%) were intubated within 8 h of presentation, and the vast majority (93%) by 24 h. Of those patients responding to medical therapy, half (52%) recovered within 24 h and the vast majority (92%) recovered within 72 h. CONCLUSIONS: This study provides a better characterization of the response to therapy of COPD patients with hypercapnic respiratory failure. This should be useful in limiting or omitting medical therapy in high-risk patients, thereby avoiding delays in intubation as well as providing a framework for continued therapy in those more likely to improve. |
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Authors:
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G W Hoo; N Hakimian; S M Santiago |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Chest Volume: 117 ISSN: 0012-3692 ISO Abbreviation: Chest Publication Date: 2000 Jan |
Date Detail:
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Created Date: 2000-02-07 Completed Date: 2000-02-07 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 169-77 Citation Subset: AIM; IM; S |
Affiliation:
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Pulmonary and Critical Care Section, West Los Angeles VAMC and UCLA School of Medicine, Los Angeles, CA 90073, USA. Guy.Soohoo@med.va.gov |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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APACHE Acidosis, Respiratory / blood, etiology Blood Urea Nitrogen Female Humans Hypercapnia / blood, etiology*, mortality, therapy Intensive Care Units Intubation, Intratracheal Lung Diseases, Obstructive / blood, complications*, mortality, therapy Male Respiration, Artificial Respiratory Function Tests Respiratory Insufficiency / blood, etiology*, mortality, therapy Retrospective Studies Survival Rate |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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