Comorbidities and Subgroups of Patients Surviving Severe Acute Hypercapnic Respiratory Failure in the Intensive Care Unit

被引:55
作者
Adler, Dan [1 ]
Pepin, Jean-Louis [4 ]
Dupuis-Lozeron, Elise [1 ,2 ]
Espa-Cervena, Katerina [1 ]
Merlet-Violet, Roselyne [2 ]
Muller, Hajo [3 ]
Janssens, Jean-Paul [1 ]
Brochard, Laurent [5 ,6 ,7 ]
机构
[1] Geneva Univ Hosp, Div Pulm Dis, 4 Rue Gabrielle Perret Gentil, CH-1211 Geneva 14, Switzerland
[2] Geneva Univ Hosp, Div Clin Epidemiol, Geneva, Switzerland
[3] Geneva Univ Hosp, Div Cardiol, Geneva, Switzerland
[4] Univ Grenoble Alpes, Inst Natl Sante & Rech Med, Lab Explorat Fonct Cardioresp,Pole Thorax & Vaiss, U1042,CHU Grenoble,Hypoxie Physiopathol, Grenoble, France
[5] Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
[6] St Michaels Hosp, Keenan Res Ctr, Toronto, ON, Canada
[7] St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada
关键词
acute hypercapnic respiratory failure; COPD; intensive care; OBSTRUCTIVE PULMONARY-DISEASE; POSITIVE-PRESSURE VENTILATION; NONINVASIVE VENTILATION; HEART-FAILURE; SLEEP-APNEA; COPD; OBESITY; HYPOVENTILATION; PREVALENCE; TERM;
D O I
10.1164/rccm.201608-1666OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationale: 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. Objectives: 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. Methods: 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. Measurements and Main Results: 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. Conclusions: 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.
引用
收藏
页码:200 / 207
页数:8
相关论文
共 37 条
[1]   Does Inspiratory Muscle Dysfunction Predict Readmission after Intensive Care Unit Discharge? [J].
Adler, Dan ;
Dupuis-Lozeron, Elise ;
Richard, Jean-Christophe ;
Janssens, Jean-Paul ;
Brochard, Laurent .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2014, 190 (03) :347-350
[2]   Impact of Noncardiac Comorbidities on Morbidity and Mortality in a Predominantly Male Population With Heart Failure and Preserved Versus Reduced Ejection Fraction [J].
Ather, Sameer ;
Chan, Wenyaw ;
Bozkurt, Biykem ;
Aguilar, David ;
Ramasubbu, Kumudha ;
Zachariah, Amit A. ;
Wehrens, Xander H. T. ;
Deswal, Anita .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2012, 59 (11) :998-1005
[3]   Rules for Scoring Respiratory Events in Sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events [J].
Berry, Richard B. ;
Budhiraja, Rohit ;
Gottlieb, Daniel J. ;
Gozal, David ;
Iber, Conrad ;
Kapur, Vishesh K. ;
Marcus, Carole L. ;
Mehra, Reena ;
Parthasarathy, Sairam ;
Quan, Stuart F. ;
Redline, Susan ;
Strohl, Kingman P. ;
Ward, Sally L. Davidson ;
Tangredi, Michelle M. .
JOURNAL OF CLINICAL SLEEP MEDICINE, 2012, 8 (05) :597-619
[4]   Long-term adherence with non-invasive ventilation improves prognosis in obese COPD patients [J].
Borel, Jean-Christian ;
Pepin, Jean-Louis ;
Pison, Christophe ;
Vesin, Aurelien ;
Gonzalez-Bermejo, Jesus ;
Court-Fortune, Isabelle ;
Timsit, Jean-Francois .
RESPIROLOGY, 2014, 19 (06) :857-865
[5]  
Borel JC, 2013, PLOS ONE, V8, DOI [10.1371/journal.pone.0052006, 10.1371/journal.pone.0052004]
[6]   Health-related quality of life and long-term prognosis in chronic hypercapnic respiratory failure: a prospective survival analysis [J].
Budweiser, Stephan ;
Hitzl, Andre P. ;
Joerres, Rudolf A. ;
Schmidbauer, Kathrin ;
Heinemann, Frank ;
Pfeifer, Michael .
RESPIRATORY RESEARCH, 2007, 8 (1)
[7]   Noninvasive Ventilation in Acute Hypercapnic Respiratory Failure Caused by Obesity Hypoventilation Syndrome and Chronic Obstructive Pulmonary Disease [J].
Carrillo, Andres ;
Ferrer, Miquel ;
Gonzalez-Diaz, Gumersindo ;
Lopez-Martinez, Antonia ;
Llamas, Noemi ;
Alcazar, Maravillas ;
Capilla, Lucia ;
Torres, Antoni .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2012, 186 (12) :1279-1285
[8]   Readmission rates and life threatening events in COPD survivors treated with non-invasive ventilation for acute hypercapnic respiratory failure [J].
Chu, CM ;
Chan, VL ;
Lin, AWN ;
Wong, IWY ;
Leung, WS ;
Lai, CKW .
THORAX, 2004, 59 (12) :1020-1025
[9]   Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome [J].
de Llano, LAP ;
Golpe, R ;
Piquer, MO ;
Racamonde, AV ;
Caruncho, MV ;
Muinelos, OC ;
Carro, CA .
CHEST, 2005, 128 (02) :587-594
[10]   Comorbidities and Risk of Mortality in Patients with Chronic Obstructive Pulmonary Disease [J].
Divo, Miguel ;
Cote, Claudia ;
de Torres, Juan P. ;
Casanova, Ciro ;
Marin, Jose M. ;
Pinto-Plata, Victor ;
Zulueta, Javier ;
Cabrera, Carlos ;
Zagaceta, Jorge ;
Hunninghake, Gary ;
Celli, Bartolome .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2012, 186 (02) :155-161