Publication: Readmission and mortality after first hospital admission with acute hypercapnic respiratory failure (AHRF) requiring non-invasive ventilation (NIV)
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Date
2013
Journal Title
Journal ISSN
Volume Title
Publisher
European Respiratory Society
Abstract
Introduction: Longer term data on mortality of patients requiring NIV due to AHRF have been reported (Thomas A et al. ERJ 2010; 36:54. 402s). We report 1-year mortality and readmission rates of a cohort of such patients admitted to a respiratory ward-based 11-bedded physiotherapy-led NIV unit in a hospital providing acute medical services to a population of about 450000.
Methods: An observational, single-centre, retrospective, follow-up study of all patients requiring NIV for AHRF (Arterial pH 7.35 and pCO2 6.0 kPa) for the first time between 01 Jan 2009 to 31 Dec 2009 was conducted.
Results: Of the 163 patients treated with NIV, data was complete on 149. Mean pH 7.21; mean FEV1 21% predicted.The most common cause for admission was exacerbation of COPD 76 (51%), followed by pneumonia 22 (14.7), Primary obese morbidity 13 (8.7%), left ventricular failure 6 (4.02%) and Multifactorial AHRF 32 (21.4%); Mortality at first admission was 38/149 (25.5%) and at 24 months was 86/149 (57.7%). Readmission for AHRF peaked at 1 year, with 32.9% of patients being readmitted at least once at 12 months after first presentation.
Discussion: Respiratory ward based NIV units in UK teaching hospitals tend to treat significantly more acidotic patients in real life than envisaged by the British Thoracic Society/Royal College of Physicians/Intensive Care Society 2008 guidelines. Allowing for that, short term (1-year) mortality and readmission rates remain similar to original studies on less severely acidotic AHRF patients, which probably indicates improved multidisciplinary team work and team learning.
Description
Keywords
Acute respiratory failure, Ventilation/NIV, Epidemiology
Citation
Readmission and mortality after first hospital admission with acute hypercapnic respiratory failure (AHRF) requiring non-invasive ventilation (NIV) Rebecca D'Cruz, Harman Saman, Olliver O'Sullivan, Norashikin Amran, Jumaa Bwika, Ben Beauchamp, Rahul Mukherjee European Respiratory Journal Sep 2013, 42 (Suppl 57) P2490;