Do high PaCO2 levels during discharge from the hospital predict medium-term mortality in chronic respiratory failure patients without domiciliary non-invasive mechanical ventilator?

Abstract

Aim: Long-term domiciliary use of a non-invasive mechanical ventilator (NIV) is a controversial form of therapy for patients with chronic obstructive pulmonary disease (COPD) and moderate hypercapnia. The present research attempted to examine hospital admissions, hospitalizations, and medium-term (6-8 months) mortality in a group of patients with compensated but moderate hypercapnia who were discharged from our clinic without a domiciliary NIV. Material and Method: The sample of this retrospective, observation-based cohort study consisted of compensated hypercapnic cases that were hospitalized in our Pulmonology Intensive Care Unit (ICU) between 01.01.2019 and 12.31.2020. Results: A total of 245 patients discharged with high partial pressure of carbon dioxide (PaCO2) levels between 01.01.2019 and 12.31.2020 were included in the study. While 58% of the cases were males (n=142), we found the mean age of the patients to be 71.89±12.63 years. The findings yielded no significant differences between the groups by sex, use of NIV during hospitalization, number of days of NIV use during hospitalization, use of LTOT or Oxygen tube at home, and intubation history before ICU admission (p>0.05). Similarly, we could not conclude significant differences between the groups by hospitalization, discharge, and follow-up arterial blood gas (ABG) parameters. Yet, the rates of congestive heart failure, coronary artery disease, and atrial fibrillation were significantly higher in the mortality group (p=0.017, p=0.032, and p=0.002, respectively). Besides, high PaCO2 levels versus mortality rates at 1, 3, 6, 8, and 12 months and in the entire follow-up period were subjected to the ROC analysis. Accordingly, when accepting 50.25 mmHg as the cut-off value for determining the 8-month mortality for discharge PaCO2 levels, we calculated the sensitivity to be 78.6% and the specificity to be 43%. Conclusion: Overall, it is highly convenient to consider the possible positive effects of NIV therapy on mortality among patients with heart-related diseases and with moderate hypercapnia (PaCO2>50 mmHg) at discharge.

Keywords

• Respiratory failure
• hypercapnia
• mortality
• ventilation

Hastaneden taburculuk sırasında yüksek PaCO2 seviyeleri, evde non-invaziv mekanik ventilatörü olmayan kronik solunum yetmezliği hastalarında orta vadeli mortaliteyi öngörüyor mu?

Abstract

Amaç: Uzun süreli evde NIV kullanımı, kompanse ılımlı hiperkapnik KOAH olan hastalar için tartışmalı bir tedavi şeklidir. Çalışmamızın amacı kliniğimizden taburcu edilen kompanse fakat ılımlı hiperkapnik hastalardan evde non-invaziv mekanik ventilatörü olmayan hasta grubunun taburculuk sonrası hastaneye başvuru sayıları, hastaneye yatış sayıları ve orta vadeli (6-8 ay) mortalite durumlarını incelemektir. Gereç ve Yöntem: Çalışma grubunu oluşturan hastalar 01.01.2019 ve 31.12.2020 tarihleri arasında Göğüs Hastalıkları Yoğun Bakım Kliniğinde yatarak tetkik edilip taburcu edilmiş kompanse hiperkapnik olgulardan oluşmaktadır. Araştırmamız retrospektif gözleme dayalı kohort çalışma olarak planlanmıştır. Bulgular: Çalışmaya 01.01.2019 ve 31.12.2020 tarihleri arasında yüksek PaCO2 düzeyiyle taburcu edilmiş toplam 245 hasta dahil edildi. Olguların %58’i erkek (n=142) cinsiyette idi. Hastaların yaş ortalaması 71,89±12,63 idi. Her iki grup arasında cinsiyet, yatışları sırasında NIV kullanımı, yatışları sırasında NIV kullanım gün sayısı, evde USOT veya Oksijen tüpü kullanımı ve GYBÜ yatışı öncesinde entübasyon öyküsü bulunması açılarından istatistiksel olarak anlamlı farklılık bulunmamaktadır (p>0,05). Mortalite grubunda konjestif kalp yetmezliği, koroner arter hastalığı ve atriyal fibrilasyon bulunma oranları istatistiksel olarak anlamlı düzeyde daha yüksektir (sırasıyla p=0,017, p=0,032 ve p=0,002). Her iki grup arasında yatış, taburcu ve kontrol sonuçları açısından istatistiksel olarak anlamlı farklı izlenmemiştir. Yüksek PaCO2 düzeyiyle taburcu olmuş olguların 1, 3, 6, 8, 12 aylık ve takip süresinin tamamındaki mortalite oranlarına karşılık taburculuk PaCO2 düzeyleri ROC analizine tabi tutulmuştur. ROC analizi sonucunda, taburculuk PaCO2 düzeyleri için 8. ay mortaliteyi belirlemede cut-off değeri 50,25 mmHg sınır değer kabul edildiğinde, duyarlılık %78,6 özgüllük %43 olarak hesaplanmıştır. Sonuç: Taburculukta ılımlı hiperkapnisi (PaCO2>50 mmHg) olan, kalp ilişkili hastalığı bulunan hasta grubunda evde NIV tedavisinin dikkatle değerlendirilmesi gerektiğini düşünüyoruz.

Keywords

• Solunum yetmezliği
• hiperkapni
• mortalite
• ventilasyon

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