Lung and respiratory muscle function at discharge from a respiratory intensive care unit.
BACKGROUND
The purpose of this prospective observational study was to describe lung and respiratory muscle function at Respiratory Intensive Care Unit (RICU) discharge after a severe exacerbation of Chronic Obstructive Pulmonary Disease (COPD).


METHODS
The study was conducted in 42 consecutive COPD patients in whom arterial blood gases, dynamic and static lung volumes, maximal inspiratory pressure (MIP) were assessed at discharge from the RICU and compared with values measured 6 months previously when they were in a stable state. The same measurements were performed at 6-month interval in 42 comparable stable COPD patients not requiring any hospitalisation for at least 6 months used as controls.


RESULTS
24% of patients in the study group were discharged with hypercapnia whereas they were normocapnic before the acute episode. Compared to prior to exacerbation, patients of study group showed a significant worsening in mean values of PaCO2 (p=0.005), MIP (p=0.005) and FEV1 (p=0.041). Predefined criteria of worsening in PaCO2, MIP and FEV1 were observed in 47%, 33% and 28% of patients in study respectively. Neither lung nor respiratory muscle function in last stable state did predict post RICU functional worsening. In a period of 6 months controls showed no change in the studied parameters.


CONCLUSIONS
After a severe acute exacerbation requiring admission to a RICU and immediately before discharge 1) a large proportion of COPD patients still show preserved lung and respiratory muscle function 2) more than one third of them would require further care and rehabilitative attempts to restore functional derangements.
Vitacca
M
M
Pulmonary Department and Respiratory Intermediate Intensive Care Unit, S Maugeri Foundation IRCCS Gussago (BS), Italy. mvitacca@fsm.it
Bianchi
L
L
Barbano
L
L
Ambrosino
N
N
D000368:Aged; D001784:Blood Gas Analysis; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D012121:Respiration, Artificial; D012124:Respiratory Care Units; D015656:Respiratory Mechanics / Q000502:physiology*; D012132:Respiratory Muscles / Q000503:physiopathology*; D012720:Severity of Illness Index; D016896:Treatment Outcome