- MeSH
- Diabetes Mellitus, Type 2 drug therapy MeSH
- Diabetes Mellitus * drug therapy metabolism therapy MeSH
- Insulin, Long-Acting pharmacology therapeutic use MeSH
- Endocrinology methods trends MeSH
- Dipeptidyl-Peptidase IV Inhibitors * administration & dosage metabolism therapeutic use MeSH
- Clinical Studies as Topic utilization MeSH
- Insulin, Short-Acting pharmacology therapeutic use MeSH
- Langerhans Cells * enzymology metabolism secretion MeSH
- Humans MeSH
- Evidence-Based Medicine methods trends MeSH
- Meta-Analysis as Topic MeSH
- Infusions, Subcutaneous methods trends utilization MeSH
- Education methods trends MeSH
- Check Tag
- Humans MeSH
- Publication type
- Interview MeSH
Úvod: Prognózu nemocných s chronickou obstrukční plicní nemocí (CHOPN) ovlivňuje četnost a tíže akutních exacerbací (AE). V léčbě těžkých AE CHOPN je využívána mechanická ventilace, preferován je neinvazivní způsob. Nemocní léčení invazivní mechanickou ventilací (IMV) mají vysoké riziko úmrtí a nízké jednoroční přežívání. Dle našich předchozích zkušeností asi 40 % nemocných na ventilátoru umírá a rovněž asi 40 % přežívá jeden rok od intubace („pravidlo 40 %“). Metodika: Do studie byli zařazeni nemocní s AE CHOPN léčení na Jednotce intenzivní respirační péče Pneumologické kliniky 2. LF UK a FN Motol pomocí IMV v letech 2009-2014. Sledován byl výsledek IMV (úmrtí či odpojení od ventilátoru) a aktuální hospitalizace (propuštění do ambulantní péče či úmrtí) a dále doba strávená na IMV a celková doba přežití od intubace. Rovněž byly hodnoceny potenciální prediktory výsledku IMV a jednoročního přežití od intubace. Výsledky: Do studie bylo zařazeno 47 pacientů (25 mužů) s mediánem (IQR) věku 67,3 (62,7-76,9) roku. Na IMV zemřelo 15 nemocných (32 %). Z nemocných odpojených od ventilátoru během následujících hospitalizací zemřelo dalších 10 osob (21 %) a do ambulantní péče bylo propuštěno 22 pacientů (47 %). V regresní analýze s adjustací na pohlaví a věk byla přítomnost dlouhodobé domácí oxygenoterapie (DDOT) nezávislým prediktorem úmrtí na IMV (p=0,049). Medián (IQR) doby IMV byl 20 (10-43) dnů a medián (IQR) přežití od okamžiku intubace činil 0,51 (0,12-1,85) roku. Jeden rok od intubace přežívalo 19 (40 %) pacientů. Závěr: Prognóza nemocných s AE CHOPN s nutností léčby pomocí IMV je nepříznivá. Na ventilátoru umírá 32 % a jednoročního přežití dosahuje 40 % nemocných. Přítomnost DDOT je nezávislým prediktorem úmrtí na IMV.
Introduction: The prognosis of patients with chronic obstructive pulmonary disease (COPD) is affected by the frequency and severity of acute exacerbations (AEs). In the treatment of severe AEs of COPD, mechanical ventilation is used, with the non-invasive approach being preferred. Patients treated with invasive mechanical ventilation (IMV) have a high risk of death and low one-year survival. According to our previous experience, about 40 % of patients die on the ventilator and about 40 % survive one year after intubation (a "40 percent rule"). Methods: Included in the study were patients with AEs of COPD treated with IMV at the Respiratory Intensive Care Unit of the Department of Pneumology, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol between 2009 and 2014. Outcomes of IMV (weaning from the ventilator or death) and subsequent hospital stay (discharge to outpatient care or death) as well as the time spent on IMV and overall survival time from intubation were analyzed. Potential predictors of IMV outcomes and one-year survival from intubation were also evaluated. Results: The study comprised 47 patients 125 males) with a median (IQR) age of 67.3 (62.7-76.9) years. Fifteen patients (32 %) died during IMV. Among those weaned from the ventilator, another 10 patients (21 %) died during their subsequent hospital stay and only 22 (47 %) persons were discharged from the hospital. In regression analysis with adjustment for age and sex, the presence of long-term oxygen therapy (LTOT) was an independent predictor of death during IMV (p = 0.049). The median (IQR) duration of IMV was 20 (10-43) days and the median (IQR) survival time from intubation was 0.51 (0.12-1.85) years. Nineteen (40 %) patients survived one year after intubation. Conclusions: The prognosis of patients with AEs of COPD requiring treatment with IMV is unfavorable. As many as 32 % of patients die during IMV and one-year survival is 40 %. The presence of LTOT is an independent predictor of death during IMV.
- Keywords
- invazivní mechanická ventilace, pravidlo 40%,
- MeSH
- Acute Disease therapy MeSH
- Survival Analysis MeSH
- Pulmonary Disease, Chronic Obstructive * diagnosis nursing therapy MeSH
- Financing, Organized MeSH
- Intensive Care Units trends utilization MeSH
- Kaplan-Meier Estimate MeSH
- Clinical Studies as Topic methods utilization MeSH
- Humans MeSH
- Prognosis * MeSH
- Disease Progression MeSH
- Statistics as Topic MeSH
- Respiration, Artificial * methods utilization MeSH
- Outcome and Process Assessment, Health Care methods trends utilization MeSH
- Check Tag
- Humans MeSH
- Keywords
- modlitba, Ramadán, péče o zemřelého, stravování, zákaz alkoholu, respektování intimity ženy, jazyková bariéra,
- MeSH
- Hygiene MeSH
- Islam * history psychology MeSH
- Clinical Studies as Topic methods utilization MeSH
- Humans MeSH
- Visitors to Patients MeSH
- Delivery of Health Care * ethics ethnology methods standards organization & administration manpower trends MeSH
- Family ethnology MeSH
- Taboo MeSH
- Nurses * standards organization & administration psychology trends MeSH
- Health Facilities ethics standards manpower utilization MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Review MeSH
- Keywords
- sladivost stévie (steviosid) 200- 300 x,
- MeSH
- Antihypertensive Agents metabolism therapeutic use MeSH
- Diterpenes metabolism therapeutic use MeSH
- Glycosides metabolism therapeutic use MeSH
- Hypolipidemic Agents * administration & dosage therapeutic use MeSH
- Clinical Studies as Topic utilization MeSH
- Humans MeSH
- Sweetening Agents * administration & dosage metabolism therapeutic use MeSH
- Statistics as Topic MeSH
- Stevia * metabolism growth & development MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- Geographicals
- Asia MeSH
- Japan MeSH
- Keywords
- výsledky studie SHARP,
- MeSH
- Azetidines administration & dosage adverse effects therapeutic use MeSH
- Diabetes Mellitus * diagnosis prevention & control MeSH
- Renal Dialysis methods trends utilization MeSH
- Edema diagnosis etiology prevention & control MeSH
- Cardiovascular Diseases * diagnosis complications prevention & control MeSH
- Clinical Studies as Topic methods standards utilization MeSH
- Humans MeSH
- Longitudinal Studies MeSH
- Death, Sudden etiology prevention & control MeSH
- Renal Insufficiency * diagnosis complications prevention & control MeSH
- Hydroxymethylglutaryl-CoA Reductase Inhibitors metabolism adverse effects therapeutic use MeSH
- Statistics as Topic MeSH
- Kidney Transplantation methods trends utilization MeSH
- Outcome and Process Assessment, Health Care MeSH
- Check Tag
- Humans MeSH
- MeSH
- Antidepressive Agents therapeutic use MeSH
- Biomedical Research methods MeSH
- Depressive Disorder * diagnosis etiology therapy MeSH
- Electroconvulsive Therapy methods utilization MeSH
- Drug Therapy methods trends utilization MeSH
- Clinical Studies as Topic methods utilization MeSH
- Congresses as Topic MeSH
- Humans MeSH
- Psychiatric Status Rating Scales * standards MeSH
- Sleep Deprivation * MeSH
- Statistics as Topic MeSH
- Outcome and Process Assessment, Health Care MeSH
- Check Tag
- Humans MeSH
- MeSH
- Central Nervous System physiopathology pathology MeSH
- Surgical Procedures, Operative * MeSH
- Clinical Studies as Topic methods utilization MeSH
- Blood Circulation physiology drug effects MeSH
- Blood Transfusion methods utilization MeSH
- Hemorrhage diagnosis etiology therapy MeSH
- Humans MeSH
- Norepinephrine administration & dosage adverse effects therapeutic use MeSH
- Pulmonary Ventilation physiology drug effects MeSH
- Resuscitation * methods instrumentation utilization MeSH
- Heart Failure * diagnosis etiology therapy MeSH
- Heart Arrest etiology therapy MeSH
- Statistics as Topic MeSH
- Outcome and Process Assessment, Health Care MeSH
- Research organization & administration MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- MeSH
- Apraxias * diagnosis etiology MeSH
- Biomedical Research methods MeSH
- Clinical Studies as Topic * methods utilization MeSH
- Disease Attributes * MeSH
- Humans MeSH
- Neurologic Manifestations MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- Keywords
- vztah expresivní a motorické afázie a apraxie,
- MeSH
- Aphasia * diagnosis etiology physiopathology MeSH
- Apraxias * diagnosis etiology physiopathology MeSH
- History of Medicine MeSH
- Clinical Studies as Topic * methods utilization MeSH
- Disease Attributes MeSH
- Humans MeSH
- Statistics as Topic MeSH
- Check Tag
- Humans MeSH
- MeSH
- Aphasia * diagnosis etiology physiopathology MeSH
- Cerebrovascular Disorders diagnosis physiopathology MeSH
- Diagnostic Techniques, Neurological MeSH
- Integumentary System Physiological Phenomena MeSH
- Clinical Studies as Topic * methods utilization MeSH
- Humans MeSH
- Meningitis diagnosis physiopathology MeSH
- Musculoskeletal System physiopathology MeSH
- Brain Neoplasms diagnosis physiopathology MeSH
- Neural Analyzers physiology physiopathology MeSH
- Auditory Pathways physiopathology MeSH
- Auditory Cortex physiology physiopathology MeSH
- Visual Pathways physiology physiopathology MeSH
- Visual Cortex physiology physiopathology MeSH
- Check Tag
- Humans MeSH