scholarly journals Correlation of Arterial Blood Gas Value with Outcome of Patient Admitted with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

2020 ◽  
Vol 3 (2) ◽  
pp. 338-342
Author(s):  
Santosh Gautam ◽  
Shiva Raj KC ◽  
Milesh Jung Sijapati ◽  
Purnima Gyawali ◽  
Geetika KC ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Respiratory Failure ◽  
Hospital Stay ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Type Ii ◽  
Blood Gas ◽  
Obstructive Pulmonary Disease ◽  
Arterial Blood Gas ◽  
Arterial Blood

Background: The outcome of Chronic Obstructive Pulmonary Disease depends upon the partial pressure of oxygen and carbon dioxide This study was aimed to find the role of arterial blood gas parameters during the length of hospital stay among patients admitted for Chronic Obstructive Pulmonary Diseasewith acute exacerbation. Materials and Methods: This was an observational study conducted in KIST Medical College Teaching Hospital from February 2017 to August 2019. Patients admitted with the chronic obstructive pulmonary disease were evaluated. Demographic data as well as oxygen saturation (SPO2), pulmonary function test, and arterial blood gas analysis were recorded and analyzed. Results: Among 112 patients, the female to male ratio was 1.38: 1 with 84.8% over 60 years of age. One-third of patients (n=38) had exposure to both tobacco smoking and biomass and of them, 86.8% were females. Mean SpO2 was 75.9% and mean FEV1 was 0.92 L (SD=0.295) and significant association was found (p<0.001) between them. Furthermore, 70 (62.5%) patients had type I respiratory failure and 42 patients (37.5%) had type II respiratory failure. Patients with type II respiratory failure and hypercapnic patients had prolonged hospital stay with significant p-value (p<0.001). Similarly, significance was observed in the p-value for acidic blood pH, which was <0.05. Conclusions: Increased length of hospital stay is seen in patients with acute exacerbation of Chronic Obstructive Pulmonary Disease with type II respiratory failure. Hence, aggressive early management to correct hypercapnia may lead to decreased hospital stay along with a better outcome. Thus hypercapnia should be considered as one of the important criteria to flag the patient and manage accordingly. 

Correlation of Arterial blood gas value in outcome of patient admitted with acute exacerbation of Chronic Obstructive Pulmonary Disease

2020 ◽  
Author(s):  
Santosh Gautam ◽  
Shiva Raj K C ◽  
Milesh Jung Sijapati ◽  
Purnima Gyawali ◽  
Geetika KC ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Respiratory Failure ◽  
Hospital Stay ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Type Ii ◽  
Blood Gas ◽  
Obstructive Pulmonary Disease ◽  
Arterial Blood Gas ◽  
Arterial Blood

Abstract Introduction: The outcome of Chronic Obstructive Pulmonary Disease depends upon the partial pressure of oxygen and carbon dioxide This study was aimed to find the role of arterial blood gas parameters during the length of hospital stay among patients admitted for COPD with acute exacerbation. Materials and Methods: This was an observational study conducted in KIST Medical College Teaching Hospital from February 2017 to August 2019. Patients admitted with chronic obstructive pulmonary disease were evaluated. Demographic data as well as SPO2, pulmonary function test, and arterial blood gas analysis were recorded and analyzed. Results: Among 112 patients, the female to male ratio was 1.38: 1 with 84.8% over 60 years of age. One-third of patients (n = 38) had exposure to both tobacco smoking and biomass and of them, 86.8% were females. Mean SpO2 was 75.9% and mean FEV1 was 0.92 L (SD = 0.295) and significant association was found (p < 0.001) between them. Furthermore, 70 (62.5%) patients had type I respiratory failure and 42 patients (37.5%) had type II respiratory failure. Patients with type II respiratory failure and hypercapnic patients had prolonged hospital stay with significant p-value (p < 0.001). Similarly, significance was observed in the p-value for blood pH, which was < 0.05. Conclusions: Increased length of hospital stay is seen in patients with AECOPD with type II respiratory failure. Hence, aggressive early management to correct hypercapnia may lead to decreased hospital stay along with a better outcome. Thus hypercapnia should be considered as one of the important criteria to flag the patient and manage accordingly.

scholarly journals The influence of oxygenotherapy on the hypercapnia in patients with chronic obstructive pulmonary disease

2008 ◽  
Vol 65 (7) ◽  
pp. 521-524
Author(s):  
Zorica Lazic ◽  
Ivan Cekerevac ◽  
Ljiljana Novkovic ◽  
Vojislav Cupurdija
Keyword(s):  
Carbon Dioxide ◽  
Chronic Obstructive Pulmonary Disease ◽  
Respiratory Failure ◽  
Pulmonary Disease ◽  
Oxygen Therapy ◽  
Chronic Obstructive ◽  
Average Increase ◽  
Obstructive Pulmonary Disease ◽  
Initial Values ◽  
Arterial Blood

Background/Aim. Oxygen therapy is a necessary therapeutic method in treatment of severe chronic respiratory failure (CRF), especially in phases of acute worsening. Risks which are to be taken into consideration during this therapy are: unpredictable increase of carbon dioxide in blood, carbonarcosis, respiratory acidosis and coma. The aim of this study was to show the influence of oxygen therapy on changes of arterial blood carbon dioxide partial pressure. Methods. The study included 93 patients in 104 admittances to the hospital due to acute exacerbation of CFR. The majority of the patients (89.4%) had chronic obstructive pulmonary disease (COPD), while other causes of respiratory failure were less common. The effect of oxygenation was controlled through measurement of PaO2 and PaCO2 in arterial blood samples. To analyze the influence of oxygen therapy on levels of carbon dioxide, greatest values of change of PaO2 and PaCO2 values from these measurements, including corresponding PaO2 values from the same blood analysis were taken. Results. The obtained results show that oxygen therapy led to the increase of PaO2 but also to the increase of PaCO2. The average increase of PaO2 for the whole group of patients was 2.42 kPa, and the average increase of PaCO2 was 1.69 kPa. There was no correlation between the initial values of PaO2 and PaCO2 and changes of PaCO2 during the oxygen therapy. Also, no correlation between the produced increase in PaO2 and change in PaCO2 during this therapy was found. Conclusion. Controlled oxygen therapy in patients with severe respiratory failure greatly reduces the risk of unwanted increase of PaCO2, but does not exclude it completely. The initial values of PaO2 and PaCO2 are not reliable parameters which could predict the response to oxygen therapy.

The Clinical Implications of Carbon Dioxide Increased Level in Arterial Blood Related to Severe Exacerbations of Chronic Obstructive Pulmonary Disease

2018 ◽  
Vol 69 (8) ◽  
pp. 2050-2053 ◽  
Author(s):  
Gabriela Jimborean ◽  
Oana Cristina Arghir ◽  
Simona Claudia Cambrea ◽  
Elena Dantes ◽  
Adriana Socaci ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Chronic Obstructive Pulmonary Disease ◽  
Respiratory Failure ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Arterial Blood ◽  
Copd Patients ◽  
Hypercapnic Encephalopathy

In the evolution of patients with chronic obstructive pulmonary disease (COPD), exacerbations occur, especially, in severe stages, determining aggravated respiratory failure and decreased survival. In order to evaluate the implications of COPD exacerbations in patients with second type of chronic respiratory failure and hypercapnic encephalopathy, a prospective observational study was done among 195 COPD in patients of Targu Mures Clinical County Hospital, Romania. Inclusion criteria consisted in severe exacerbations of COPD, complicated by hypercapnia, defined by an increased level of arterial blood gas carbon dioxide (PaCO2) �45 mmHg, suggestive for the second type of respiratory failure. The increased values of PaCO2 ranged between 45 and 112 mmHg among 95 patients. The prevalence of hypercapnia in COPD patients, admitted in hospital for severe exacerbations, was high (n=91/195; 46.66%). The majority of COPD patients (93.4%) were initially hospitalized in the intensive care unit (ICU) department because of hypercapnic encephalopathy. The mortality rate was higher among patients with endotracheal tube insertion than in patients treated by noninvasive mechanical ventilation. High levels of hypercapnia, conscience disorders and respiratory acidosis may be considered factors of severity in COPD exacerbation.

scholarly journals BAP 65 and DECAF scores in Predicting Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Prospective Observational Study

2020 ◽  
Author(s):  
Sashideep Reddy Telukutla ◽  
TA Vidya ◽  
SK Nellaiappa Ganesan
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Mechanical Ventilation ◽  
Predictive Value ◽  
Prospective Observational Study ◽  
Chronic Obstructive ◽  
Blood Gas ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Arterial Blood Gas ◽  
Arterial Blood

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is the fourth most common cause of mortality in the world. Acute Exacerbation of COPD (AECOPD) is a common entity to the emergency room of physician. It also contributes to the morbidity and mortality of the disease. Since multiple factors influence the outcomes of AECOPD, many prognostic indices incorporating various parameters have been proposed. BAP 65 {Blood Urea Nitrogen (BUN), Altered mental status, Pulse rate and age >65 years} and Dyspnoea grade, Eosinopenia, Consolidation, Acidemia and Atrial fibrillation (DECAF) are two which are commonly used. Head-to-head comparisons of these scores in their ability to correctly predict outcomes will aid the clinician in decision-making. Aim: To evaluate the performance of BAP 65 and DECAF scores in accurately predicting need for mechanical ventilation and mortality in patients with AECOPD. Materials and Methods: In this prospective observational study, 170 patients presenting with AECOPD to the emergency department were recruited consecutively. All patients were clinically examined and all variables for the calculation of the two scores were documented at baseline. Routine neurological examination was used to determine altered sensorium at admission. Following this, all patients underwent appropriate investigations including chest X-ray, Electrocardiogram (ECG) and arterial blood gas estimation. BAP 65 and DECAF scores were recorded and patients were followed till death or improvement. The results were analysed using Statistical Package for the Social Sciences (SPSS) software version 23. Student’s t-test, Mann-Whitney test and Chi-square test were used depending on the type of variables. Receiver Operating Characteristic (ROC) analysis was done and Area Under the Curve (AUC) was determined. A p-value <0.5 was deemed to be significant for all tests. Results: Out of 170 patients, 48 required non-invasive ventilation and 30 required invasive ventilation and 23 (13.5%) expired. Mortality correlated significantly with age, median years of COPD, smoking pack years and hospitalisations in the past one year and also with lower haemoglobin and higher total leucocyte counts and BUN values. Both BAP 65 and DECAF scores correlated with need for mechanical ventilation and mortality. Area Under Receiver Operator Characteristic Curves (AUROC) predicting mortality was 0.712 for BAP 65 and 0.965 for DECAF scores. AUROC predicting need for ventilation was 0.583 for BAP 65 and 0.791 for DECAF scores. DECAF showed sensitivity of 78.26%, specificity of 95.92%, Positive Predictive Value (PPV) of 75%, Negative Predictive Value (NPV) of 96.58%, with an accuracy of 87.09% in predicting mortality. In predicting need for mechanical ventilation, DECAF had sensitivity of 32.14%, specificity of 94.74%, PPV of 75%, NPV of 73.97% with an accuracy of 63.44%. DECAF showed a higher positive predictive value for both outcomes. Conclusion: History and basic clinical examination provide a lot of data to formulate prognosis in AECOPD. In resource-poor settings, BAP 65 can be used while DECAF can be used where arterial blood gas analysis is readily available, since both have proven to correlate with outcomes.

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