Ilknur Naz

A Randomized Controlled Trial Comparing the Ventilation Duration Between Adaptive Support Ventilation and Pressure Assist/Control Ventilation in Medical Patients in the ICU

BACKGROUND Adaptive support ventilation (ASV) is a closed loop mode of mechanical ventilation (MV) that provides a target minute ventilation by automatically adapting inspiratory pressure and respiratory rate with the minimum work of breathing on the part of the patient. The aim of this study was to determine the effect of ASV on total MV duration when compared with pressure assist/control ventilation. METHODS Adult medical patients intubated and mechanically ventilated for > 24 h in a medical ICU were randomized to either ASV or pressure assist/control ventilation. Sedation and medical treatment were standardized for each group. Primary outcome was the total MV duration. Secondary outcomes were the weaning duration, number of manual settings of the ventilator, and weaning success rates. RESULTS Two hundred twenty-nine patients were included. Median MV duration until weaning, weaning duration, and total MV duration were significantly shorter in the ASV group (67 [43-94] h vs 92 [61-165] h, P = .003; 2 [2-2] h vs 2 [2-80] h, P = .001; and 4 [2-6] days vs 4 [3-9] days, P = .016, respectively). Patients in the ASV group required fewer total number of manual settings on the ventilator to reach the desired pH and Paco2 levels (2 [1-2] vs 3 [2-5], P < .001). The number of patients extubated successfully on the first attempt was significantly higher in the ASV group (P = .001). Weaning success and mortality at day 28 were comparable between the two groups. CONCLUSIONS In medical patients in the ICU, ASV may shorten the duration of weaning and total MV duration with a fewer number of manual ventilator settings. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01472302; URL: www.clinicaltrials.gov.

Effectiveness and safety of a protocolized mechanical ventilation and weaning strategy of COPD patients by respiratory therapists.

INTRODUCTION Prior researches have showed that weaning protocols may decrease the duration of mechanical ventilation. The effect of these protocols on chronic obstructive pulmonary disease (COPD) patients is unknown. The purpose of this study was to evaluate the impact of an extensive mechanical ventilation protocol including weaning applied by a respiratory therapist (RT) on the duration of mechanical ventilation and intensive care unit (ICU) stay in COPD patients. MATERIALS AND METHODS A novel mechanical ventilation protocol including weaning was developed and initiated for all intubated COPD patients by a respiratory therapist. Outcomes of patients treated using this protocol during a 6-month period were compared to those of patients treated by physicians without a protocol during the preceding 6 months. RESULTS A total of 170 patients were enrolled. Extubation success was significantly higher (98% vs. 78%, P=0.014) and median durations of weaning, mechanical ventilation and ICU stay compared with time to event analysis were significantly shorter in the protocol based group (2 vs. 26 hours, log rank P<0.001, 3.1 vs. 5 days, log rank P<0.001 and 6 vs. 12 days, log rank P<0.001, respectively). Patients who were successfully extubated and patients in the protocol based group were more likely to have shorter ventilation duration [HR: 1.87, 95% confidence intervals (CI): 1.13-3.08, P=0.015 and HR: 2.08, 95% CI: 1.40-3.10, P<0.001 respectively]. CONCLUSIONS In our center, a protocolized mechanical ventilation and weaning strategy improved weaning success and shortened the total duration of mechanical ventilation and ICU stay in COPD patients requiring mechanical ventilation.

Effectiveness of Pulmonary Rehabilitation in COPD Patients Receiving Long-Term Oxygen Therapy.

It has been demonstrated that long‐term oxygen therapy increased exercise capacity, improved the quality of life, reduced hospitalization and increased life expectancy in chronic hypoxemic COPD patients. The present study aims to evaluate the effectiveness of pulmonary rehabilitation (PR) in COPD patients receiving long‐term oxygen therapy (LTOT) compared to COPD patients not receiving LTOT.

Is a pulmonary rehabilitation program effective in COPD patients with chronic hypercapnic failure

ABSTRACT Objectives: Our study aimed to compare the effectiveness of a pulmonary rehabilitation (PR) program between hypercapnic and normocapnic patients with chronic obstructive pulmonary disease (COPD). Methods: Hypercapnic (Group 1) and normocapnic (Group 2) patients with COPD who participated in this study underwent a comprehensive 8-week out-patient PR program. Results: A total of 122 patients were enrolled in the study; (n:86, n:36 groups 1 and 2, respectively.) After PR, both groups had better symptom scores as well as physical, social and emotional functioning. In addition, the groups had reduced dyspnea, anxiety and depression scores. After PR, the hypercapnic group improved significantly more in exercise capacity (∆6 MWT 50 m. vs 40 m.) compared with normocapnic patients (p=0.044). The hypercapnic group demonstrated a significant reduction in the PaCO2 levels after PR within (p<0.05) and between groups (p<0.0001). Conclusions: Given the significant reductions in pCO2 levels and significant increases in exercise capacity and QoL parameters after PR, the patients with chronic hypercapnic failure apparently benefited from the PR.

The effect of obesity on dyspnea, exercise capacity, walk work and workload in patients with COPD

Introduction COPD and obesity are major public health problems that cause mortality and morbidity all over the world. The combined of COPD and obesity is predicted to increase further in the coming years. Obesity primarily affects the pulmonary system by altering respiratory functions, exercise capacity, pulmonary gas exchange, and endurance and power of respiratory muscles. In this study, we aimed to compare the dyspnea sensation, exercise capacity, walk work and workload in obese COPD patients compared to preobese and normal overweight COPD patients. Materials and Methods 218 patients with COPD were included in the study. According to the WHO criteria for body mass index (BMI), the patients were classified as normal-weight (BMI=18.5-24.9 kg/m2), pre-obese (BMI= 25-29.9 kg/m2) and obese (BMI= 30-39.9 kg/m2). All patient respiratory function tests and arterial blood gas analysis were performed. The mMRC dyspnea scale was used to assess the dyspnoea of the patients. The exercise capacities of the patients were determined by the 6-min walking test. Walk work and workload were calculated based on 6 minutes walking distance. The obtained values were compared between the three groups. Result The FEV1/FVC ratio and TLCO value in pulmonary function tests are significantly higher in obese COPD patients than in other patients, while the VC value is significantly lower in patients with COPD (p= 0.001, p< 0.001, p= 0.01). Partial carbon dioxidewas significantly higher in obese COPD patients compared to other patients (p= 0.001). Dyspnea perceptions and walking distances did not differ significantly between groups. Walkwork and workload were significantly higher in obese COPD patients (p< 0.001, p= 0.005). Conclusions Obesity causes partial changes in blood gas and pulmonary function tests of patients with COPD. At the same time, it increases walkwork and workload. Despite all these changes, it has no negative effect on dyspnea perception and exercise capacity.

The effects of smoking on body composition, pulmonary function, physical activity and health-related quality of life among healthy women

Introduction Smoking leads to more respiratory symptoms and negative effects on the health-related quality of life (HRQOL) in women than men for the same smoking burden. However, the relationship between smoking and body composition and its influencing factors remains unclear. In this study, we aim to investigate the effects of smoking on body composition, pulmonary function, physical activity and health-related quality of life (HRQOL) among healthy women. Materials and Methods A total of 73 young healthy women, current cigarette smokers and who had never smoked were included. The level of physical activity was assessed using the International Physical Activity Questionnaire; body mass index, circumference measurements, waist-to-hip ratio, skinfold measurements and body fat percentage were used to determine the body composition; HRQOL was assessed through the World Health Organization Quality of Life Instrument; level of depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale; pulmonary functions were evaluated with spirometry. Result We found higher incidence of respiratory symptoms and lower physical activity levels in smokers than those of non-smokers (p< 0.05). There was no significant difference between smokers and non-smokers in respect of HRQOL, depression and anxiety (p> 0.05). In smokers whom cigarette consumption more than 150 p-years, we observed positive correlations between cigarette consumption and arm circumference, waist circumference, waist-to-hip ratio (p< 0.05). Conclusions Our results show that the smoking causes an increase in the incidence of respiratory symptoms and reduces the level of physical activity in healthy women. Additionally it leads to abdominal obesity depending on cigarette consumption.

The effect of pulmonary rehabilitation on COPD exacerbation frequency per year.

We aimed to investigate the effect of pulmonary rehabilitation (PR) on the number of exacerbations in chronic obstructive pulmonary diseases (COPD) patients.

The effect of obesity on dyspnea, 6 minute walk distance, walk work and workload in patients with COPD

Aim: We aim to compare normal-weight COPD patients with obese and pre-obese COPD patients with respect to perceived dyspnea, exercise capacities, walkwork and workload. Material-Method: 218 patients with COPD were included in the study. We performed respiratory and cardiac system examinations and pulmonary function tests (PFT) for all cases. Their chest radiography images and arterial blood gases (ABG) analysis were evaluated. Cases also underwent a 6-minute walking test (6mWT). Walkwork and workload are calculated accordingly. Results: There was 72 normal-weight, 80 pre-obese, and 66 obese patients with COPD. The gender, age and mMRC dyspnea scores’ distribution followed a similar pattern in all three groups (p>0.05 for all). Every group had a significantly different workload mean (p=0.005). The post-hoc analysis revealed a significantly higher workload mean exhibited by the obese in comparison to that of the normal-weight patients (p 0.05). Conclusion: We observed no increase in perceived dyspnea despite increased workload in obese patients. Their exercise performance did not decrease but functional capacities increased.

Fatigue perception and related factors in patients with advanced sarcoidosis and COPD patients

Aim: To compare the fatigue symptom, which is related to pulmonary functions strongly, in two distinct lung diseases (Sarcoidosis and COPD) with different etiologies. Methods: Seventeen patients (mean age= 55.82±6.54) with sarcoidosis in stage 3-4 and 31 patients (mean age= 65.52±10.50) with stage 3-4 COPD were included. Perceived fatigue level (Fatigue Severity Scale), dyspnea severity (modified Medical Research Council scale (MMRCS) and Modified Borg Scale (MBS)), pulmonary function tests (spirometer), functional level (6-minute walking test), Health-related quality of life-HRQOL (St. George Quality of Life questionnaire and Short Form-36 (SF-36)), and depression and anxiety (Hospital Anxiety and Depression Scale (HAD)) were assessed. Results: Mean perceived fatigue severity scores were 48.32±10.62 in COPD and 37.82±13.61 in sarcoidosis group (p=0.25). Six-minute walking distance, dyspnea severity, and anxiety and depression were found similar between groups (p>0.05). Sarcoidosis patients showed lower St. George Quality of Life scores, but higher SF-36 scores in comparison to COPD patients. Pulmonary functions were found more diminished in COPD group (p= 0.04). Fatigue severity was found related to MMRCS, MBS, %FEV1 value, HAD, HRQOL scores in COPD group and MMRCS, MBS, walking distance, body-mass index, HRQOL scores in sarcoidosis group (p Conclusion: We believe that while the fatigue severity which was found higher in COPD patients was affected by lower pulmonary functions and poor quality of life, in sarcoidosis patients fatigue symptom along with the dyspnea limits the exercise capacity of patients and affects the quality of life negatively.

Association between Emergency Visits with Acute Exacerbation and Exercise Performance in Chronic Obstructive Pulmonary Disease

INTRODUCTION Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and morbidity worldwide; however, it is also a chronic disease with increasing prevalence despite medical treatment (1, 2). Acute exacerbation of COPD, which is the most common cause of hospital visits, may appear at any stage of the disease; its frequency and severity increases with disease severity (3, 4). Accelerated reduction in forced expiratory volume in one second (FEV1), which is the primary determinant of pulmonary function and exacerbation, increases the severity of the disease, reduces the quality of life of patients, and increases health expenditures (5-7). Serious exacerbations requiring hospitalization are the leading causes of mortality and morbidity in COPD (8).