Acidosis, non-invasive ventilation and mortality in hospitalised COPD exacerbations
被引:156
作者:
Roberts, C. M.
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Royal Coll Physicians, Clin Effectiveness & Evaluat unit, London NW1 4LE, England
Queen Mary Univ London, Barts & London Sch Med & Dent, London, EnglandRoyal Coll Physicians, Clin Effectiveness & Evaluat unit, London NW1 4LE, England
Roberts, C. M.
[1
,2
]
Stone, R. A.
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Royal Coll Physicians, Clin Effectiveness & Evaluat unit, London NW1 4LE, England
Taunton & Somerset NHS Trust, Musgrove Pk Hosp, Taunton, Somerset, EnglandRoyal Coll Physicians, Clin Effectiveness & Evaluat unit, London NW1 4LE, England
Stone, R. A.
[1
,3
]
Buckingham, R. J.
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Royal Coll Physicians, Clin Effectiveness & Evaluat unit, London NW1 4LE, EnglandRoyal Coll Physicians, Clin Effectiveness & Evaluat unit, London NW1 4LE, England
Buckingham, R. J.
[1
]
Pursey, N. A.
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Royal Coll Physicians, Clin Effectiveness & Evaluat unit, London NW1 4LE, EnglandRoyal Coll Physicians, Clin Effectiveness & Evaluat unit, London NW1 4LE, England
Pursey, N. A.
[1
]
Lowe, D.
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Royal Coll Physicians, Clin Effectiveness & Evaluat unit, London NW1 4LE, EnglandRoyal Coll Physicians, Clin Effectiveness & Evaluat unit, London NW1 4LE, England
Lowe, D.
[1
]
机构:
[1] Royal Coll Physicians, Clin Effectiveness & Evaluat unit, London NW1 4LE, England
[2] Queen Mary Univ London, Barts & London Sch Med & Dent, London, England
Background Reports of non-invasive ventilation (NIV) use in clinical practice reveal higher mortality rates than in corresponding randomised clinical trials. Aim To explore factors related to chronic obstructive pulmonary disease (COPD) admissions and NIV use that may explain some of the previously reported high mortality rates. Methods National UK audit of clinical care of consecutive COPD admissions from March to May 2008. Retrospective case note audit with prospective case ascertainment. Participating units completed a web-based audit proforma of process and outcomes of clinical care. Results 232 hospital units collected data on 9716 patients, mean age 73, 50% male. 1678 (20%) of those with gases recorded on admission were acidotic and another 6% became acidotic later. 1077 patients received NIV, 55% had a pH<7.26 and 49% (305/618) had or were still receiving high flow oxygen. 30% (136/453) patients with persisting respiratory acidosis did not receive NIV while 11% (15/131) of acidotic admissions had a pure metabolic acidosis and did. Hospital mortality was 25% (270/1077) for patients receiving NIV but 39% (86/219) for those with late onset acidosis and was higher in all acidotic groups receiving NIV than those treated without. Only 4% of patients receiving NIV who died had invasive mechanical ventilation. Conclusions COPD admissions treated with NIV in usual clinical practice were severely ill, many with mixed metabolic acidosis. Some eligible patients failed to receive NIV, others received it inappropriately. NIV appears to be often used as a ceiling of treatment including patient groups in whom efficacy of NIV is uncertain. The audit raises concerns that challenge the respiratory community to lead appropriate clinical improvements across the acute sector.
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Iowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Univ Iowa, Carver Coll Med, Div Gen Internal Med, Iowa City, IA USAIowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Cannon, Katrina T.
;
Sarrazin, Mary Vaughan
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Iowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Univ Iowa, Carver Coll Med, Div Gen Internal Med, Iowa City, IA USAIowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Sarrazin, Mary Vaughan
;
Rosenthal, Gary E.
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Iowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Univ Iowa, Carver Coll Med, Div Gen Internal Med, Iowa City, IA USAIowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Rosenthal, Gary E.
;
Curtis, Ann E.
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Iowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Univ Iowa, Carver Coll Med, Div Gen Internal Med, Iowa City, IA USAIowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Curtis, Ann E.
;
Thomas, Karl W.
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Iowa City VA Med Ctr, Dept Primary & Special Med, Iowa City, IA USA
Univ Iowa, Carver Coll Med, Div Pulm Crit Care & Occupat Med, Iowa City, IA USAIowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Thomas, Karl W.
;
Kaldjian, Lauris C.
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Iowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Univ Iowa, Carver Coll Med, Div Gen Internal Med, Iowa City, IA USA
Univ Iowa, Carver Coll Med, Program Bioeth & Humanities, Iowa City, IA USAIowa City VA Med Ctr, CRIISP, Iowa City, IA USA
机构:
Iowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Univ Iowa, Carver Coll Med, Div Gen Internal Med, Iowa City, IA USAIowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Cannon, Katrina T.
;
Sarrazin, Mary Vaughan
论文数: 0引用数: 0
h-index: 0
机构:
Iowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Univ Iowa, Carver Coll Med, Div Gen Internal Med, Iowa City, IA USAIowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Sarrazin, Mary Vaughan
;
Rosenthal, Gary E.
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机构:
Iowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Univ Iowa, Carver Coll Med, Div Gen Internal Med, Iowa City, IA USAIowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Rosenthal, Gary E.
;
Curtis, Ann E.
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机构:
Iowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Univ Iowa, Carver Coll Med, Div Gen Internal Med, Iowa City, IA USAIowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Curtis, Ann E.
;
Thomas, Karl W.
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机构:
Iowa City VA Med Ctr, Dept Primary & Special Med, Iowa City, IA USA
Univ Iowa, Carver Coll Med, Div Pulm Crit Care & Occupat Med, Iowa City, IA USAIowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Thomas, Karl W.
;
Kaldjian, Lauris C.
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机构:
Iowa City VA Med Ctr, CRIISP, Iowa City, IA USA
Univ Iowa, Carver Coll Med, Div Gen Internal Med, Iowa City, IA USA
Univ Iowa, Carver Coll Med, Program Bioeth & Humanities, Iowa City, IA USAIowa City VA Med Ctr, CRIISP, Iowa City, IA USA