Prognostic Value of Oxygenated Hemoglobin Assessed during Acute Exacerbations of Chronic Pulmonary Disease

Oxygenated hemoglobin as prognostic marker among patients with systemic sclerosis screened for pulmonary hypertension

Oxygenated hemoglobin (OxyHem) in arterial blood may reflect disease severity in patients with systemic sclerosis (SSc). The aim of this study was to analyze the predictive value of OxyHem in SSc patients screened for pulmonary hypertension (PH). OxyHem (g/dl) was measured by multiplying the concentration of hemoglobin with fractional oxygen saturation in arterialized capillary blood. Prognostic power was compared with known prognostic parameters in SSc using uni- and multivariable analysis. A total of 280 SSc patients were screened, 267 were included in the analysis. No signs of pulmonary vascular disease were found in 126 patients, while 141 patients presented with mean pulmonary arterial pressure ≥ 21 mmHg. Interstitial lung disease (ILD) was identified in 70 patients. Low OxyHem ≤ 12.5 g/dl at baseline was significantly associated with worse survival (P = 0.046). In the multivariable analysis presence of ILD, age ≥ 60 years and diffusion capacity for carbon monoxide (DLCO) ≤ 65% were negatively associated with survival. The combination of low DLCO and low OxyHem at baseline could predict PH at baseline (sensitivity 76.1%). This study detected for the first time OxyHem ≤ 12.5 g/dl as a prognostic predictor in SSc patients. Further studies are needed to confirm these results.

[What have we learned from the German COPD cohort COSYCONET and where do we go from here?]

COSYCONET 1 is the only German COPD cohort which is large enough to be internationally comparable. The recruitment, which started in 2010 and ended in December 2013, comprised 2741 patients with the diagnosis of COPD who were subsequently investigated in regular follow-up visits. All visits included a comprehensive functional and clinical characterisation. On the basis of this detailed data set, it was possible to address a large number of clinical questions. These questions ranged from the prescription of medication, the detailed analysis of comorbidities, in particular cardiovascular disease, and biomarker assessment to radiological and health-economic aspects. Currently, more than 60 publications of COSYCONET data are internationally available. The present overview provides a description of all the results that were obtained, focussing on the relationship between different clinical and functional aspects as well as their potential practical consequences. In addition, information on the follow-up study COSYCONET 2 is given.

[Outcome in Prolonged Weaning - Results of a Regional Weaning Center]

BACKGROUND

 The number of patients with prolonged mechanical ventilation is increasing. Weaning units (WU) in the German network "WeanNet" are specialized in the treatment of patients needing prolonged weaning. In this study we present outcome data on the patients in our WU from 2011 to 2015.

METHODS

 A distinction is made between the 4 outcome groups: 1. Successful weaning without mechanical ventilation, 2. Successful weaning with non-invasive mechanical ventilation (NIV), 3. Weaning failure with subsequent invasive ventilation and 4. Death in the WU.

RESULTS

 In 272 patients, the following distribution within the 4 outcome groups was found: Group 1: 116 patients (42.6 %), Group 2: 52 patients (19.1 %), Group 3: 45 patients (16.5 %) and Group 4: 59 patients (21.7 %).The duration of treatment in the WU depended primarily on co-morbidities and the hemoglobin level.Despite successful weaning, the tracheostoma was completely closed in only 60.3 % of patients with continuous spontaneous breathing and 67.3 % of patients with NIV at the time of discharge from the clinic.After discharge from the WU, patients with weaning failure and subsequent invasive long-term ventilation, in contrast to patients with successful weaning, were rarely transferred to rehabilitation, but re-admitted more frequently to the clinic as emergency cases (29 %).The 1-year survival rate was 59 %. Half of the patients died in less than 2 years.

CONCLUSION

 The majority of patients with prolonged mechanical ventilation are successfully weaned from the respirator in the WU. Nevertheless, the proportion of patients with weaning failure and subsequent invasive long-term out-of-hospital ventilation as well as the mortality rate in the WU and after discharge were high. The ethical implications of these observations are discussed in the paper.