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Obstructive Lung Diseases |

Prehospital Management of COPD Patients in Respiratory Failure and Short-term Outcome

Jerome Cuny, MD; Guilaume Campagne, MD; Nathalie Assez, MD; Patrick Goldstein, MD; Eric Wiel, PhD
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University Hospital of Lille, Lille, France


Chest. 2013;144(4_MeetingAbstracts):724A. doi:10.1378/chest.1670634
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Abstract

SESSION TITLE: COPD Treatment Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Respiratory failure in COPD patients is a frequent call in French emergency dispathching center. We have evaluated the pre-hospital management of COPD patients, severity signs, and analyse outcome in emergency department or ICU.

METHODS: We conducted an observational, descriptive, retrospective, single-center during a 4 months period. All COPD patients with respiratory failure and pre-hospital care were included. Different data were recorded.

RESULTS: 90 patients were included (77% male, 23% female). Mean age 69 years old (+/-11.88). 55% were smokers, 52% had arterial Hypertension, 39% recieved long-term oxygenotherapy, 18% recieved antibiotics in the 7 days before, 18 % corticosteroids, 14% were on long term NIV support at home. A Emergency medical ambulance were immediatelly sent for 86% of patients. 92% have normal consciousness (Glasgow coma scale at 15), 78% had bronchospasm, 71% had signs of respiratory struggle, 12% were unable to speak. The mean respiratory rate was 31.4 cycles/min (+/-8.18), the average cardiac pulse were 103.6 beats per minute (+/-23.14). Nasal EtCO2 44.92 mm Hg (+/-16.38), Pulse oximetry with air was 83.48% (+/-12.09), the average flow rate of oxygen delivered was 5.69 liters per minute (+/-2.93). None of the patients had fever. 85% were supported in Spontaneous Ventilation, 22% received pre-hospital Non invasive Ventilation, they all showed signs of severity and 3% need Tracheal intubation. 75% of patients received beta2-agonist and anticholinergic nebulization, 45% intravenous corticosteroids. 71% were admitted to the emergency room, 29% in the ICU.

CONCLUSIONS: Most of the patients had signs of severity and bronchospasm. The absence of fever and antibiotic allows us to think that the cause of decompensation is not a pneumonia. Although most of them were hypoxic and hypercapnic, they seem to be good candidate for NIV support in the pre-hospital care. Very fiew study repport the use of NIV in case of COPD respiratory failure in the first care delivered at home.

CLINICAL IMPLICATIONS: Antoine G. The epidemiology and outcome of medical emergency team call patients treated with non invasive ventilation. Resuscitation 82(2011)1218-1223

DISCLOSURE: The following authors have nothing to disclose: Jerome Cuny, Guilaume Campagne, Nathalie Assez, Patrick Goldstein, Eric Wiel

No Product/Research Disclosure Information


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