title: Comorbidities and Subgroups of Patients Surviving Severe Acute Hypercapnic Respiratory Failure in the Intensive Care Unit.
abstract: No methodical assessment of the lung, cardiac, and sleep function of patients surviving an acute hypercapnic respiratory failure episode requiring admission to the intensive care unit (ICU) has been reported in the literature.
  
  
  
  To prospectively investigate the prevalence and impact of comorbidities in patients treated by mechanical ventilator support (invasive or noninvasive) for acute hypercapnic respiratory failure in the ICU.
  
  
  
  Seventy-eight consecutive patients admitted for an episode of acute hypercapnic respiratory failure underwent an assessment of lung, cardiac, and sleep function by pulmonary function tests, transthoracic echocardiography, and polysomnography 3 months after ICU discharge.
  
  
  
  Sixty-seven percent (52 of 78) of patients exhibited chronic obstructive pulmonary disease (COPD), although only 19 had been previously diagnosed. Patients without COPD were primarily obese. Prevalence of severe obstructive sleep apnea was 51% (95% confidence interval, 34-69) in patients with COPD and 81% (95% confidence interval, 54-96) in patients without COPD. Previously undiagnosed cardiac dysfunction with preserved ejection fraction was highly prevalent (44%), as was hypertension (67%). More than half of the population demonstrated at least three major comorbidities known to precipitate acute hypercapnic respiratory failure. Multimorbidity was associated with longer time to hospital discharge. Hospital readmission or death occurred in 46% of patients over an average of 3.5 months after discharge.
  
  
  
  Severe hypercapnic respiratory failure requiring ICU admission resulted primarily from COPD or obesity. Major comorbidities are highly prevalent in both cases and most often ignored. Surviving acute hypercapnic respiratory failure should be an opportunity to systematically evaluate lung, heart, and sleep functions to improve poor outcomes. Clinical trial registered with www.clinicaltrials.gov (NCT 02111876).
authors.affiliation: 1 Division of Pulmonary Diseases.
authors.forename: Dan
authors.initials: D
authors.lastname: Adler
authors.affiliation: 2 Université Grenoble Alpes, Hypoxie Physiopathologie, Institut National de la Santé et de la Recherche Médicale, U1042, CHU de Grenoble, Laboratoire Exploration Fonctionelle Cardiorespiratoire, Pôle Thorax et Vaisseaux, Grenoble, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pépin
authors.affiliation: 1 Division of Pulmonary Diseases.|3 Division of Clinical Epidemiology, and.
authors.forename: Elise
authors.initials: E
authors.lastname: Dupuis-Lozeron
authors.affiliation: 1 Division of Pulmonary Diseases.
authors.forename: Katerina
authors.initials: K
authors.lastname: Espa-Cervena
authors.affiliation: 3 Division of Clinical Epidemiology, and.
authors.forename: Roselyne
authors.initials: R
authors.lastname: Merlet-Violet
authors.affiliation: 4 Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Hajo
authors.initials: H
authors.lastname: Muller
authors.affiliation: 1 Division of Pulmonary Diseases.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Janssens
authors.affiliation: 5 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; and.|6 Keenan Research Centre and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
mesh_terms: D000368:Aged; D015897:Comorbidity; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000503:physiopathology; D006331:Heart Diseases / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D007362:Intensive Care Units; D008168:Lung / Q000503:physiopathology; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D017286:Polysomnography / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000503:physiopathology; D012121:Respiration, Artificial; D012129:Respiratory Function Tests / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000503:physiopathology; D017741:Survivors; D013557:Switzerland / Q000453:epidemiology
keywords: COPD; acute hypercapnic respiratory failure; intensive care