Anil Kumar K

Abstract

Background: Physicians lack a robust and validated method of measuring severity or predicting poor outcome in patients with acute exacerbation of COPD (AECOPD). To study the prognosis in COPD patients with acute exacerbation using CAUDA 70 score. Materials and Methods: 104 patients of age more than 40 years with acute exacerbation of COPD admitted department of respiratory medicine, narayana medical college and hospital, Nellore. CAUDA 70: C: Confusion, Acidosis (pH 7mmol/L, MRC Dyspnoea score >4, Albumin 70 years. One point was assigned to each variable present, giving a six point scoring system. The patients were followed up upto discharge and the outcome of the patients was correlated with the score to analyse prognosis. Results: 29(27.8%) patients obtained score upto 2. In these patients, 24 (82.75%) recovered without ventilation, 5 (17.24%) required NIV and no patients required invasive ventilation and there were no deaths in patients with this score. 75(72.2%) patients obtained scores of 3 to 6. In these, 48(64%) patients required NIV, 15(20%) patients required invasive ventilation, 4 (5.3%) patients died and only 8 (10.66%) patients recovered without any ventilation. Conclusions: CAUDA 70 score proved to be an effective scoring system in predicting the prognosis in Acute Exacerbation of COPD patients. Keywords: Acute Exacerbation of COPD; CAUDA 70 score; Mechanical ventilation.

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Abstract

Introduction: Postoperative pulmonary complications (PPC) are the main source of postoperative morbidity and mortality. Chronic Obstructive pulmonary Disease (COPD) patients are at 3 times more risk for the development of PPCs. Spirometry is commonly done as a part of preoperative evaluation. Our objective is to assess role of spirometry to predict PPCs in patients with stable COPD following laparoscopic Cholecystectomy. Material and Methods: This is a prospective observational study at a tertiary care centre. The study was approved by institutional ethics committee. 134 stable COPD patients posted for elective laparoscopic cholecystectomy under combined general epidural anaesthesia were included. Detailed clinical history was taken, physical examination was done, quality of life was assessed by COPD Assessment Test (CAT) score, chest X-ray, ABG, ECG, 2 D Echo, Spirometry, 6 minute walk test (6MWT) were done. Patients were followed up till discharge. Data of was analyzed by SPSS 11. Results: Out of 134 patients 112 (83.6%) were males and 22 (16.4%) were females. All were of more than 40yrs. All patients had CAT score > 10. 68 males and 16 females had FEV1 (Forced expiratory volume in 1 second) < 50> Conclusion: In patients with stable COPD of known severity, preoperative spirometry may not provide additional information in predicting PPC. Routine spirometry and arterial blood gases are not required for preoperative pulmonary evaluation in patients with stable COPD prior to laparoscopic cholecystectomy. Keywords: Preoperative; Spirometry; Pulmonary disease; Chronic obstructive; Postoperative complications.

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