Online ISSN: 2515-8260

Keywords : AECOPD

Effect of Diabetes mellitus in patients with acute exacerbation of the chronic obstructive pulmonary disease

Dr. Kodithyala Prashanth Kumar; Dr. Ruchi Thakur; Dr. M Prathyusha; Dr. M. Siva Ashish

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 1739-1751

Background: Acute exacerbation chronic obstructive pulmonary disease (AECOPD) is the leading morbidity and mortality cause worldwide. Many studies showed the association of hyperglycaemia with poor results from a wide range of acute illnesses.
 Aim and Objectives: To investigate the association between concentrations of blood glucose & clinical outcomes in AECOPD patients admitted to the hospital.
Material and Methods: This is a hospital-based retrospective analysis carried out on AECOPD patients admitted during the period of January 2021 to March 2022. Detailed history, clinical examination, blood investigations were performed. Random blood glucose levels at the admission were noted, and the subjects were separated into groups of four on the basis of blood glucose levels (≤ 140 mg/dl, 141- 170 mg/dl, 171-200 mg/dl, >200 mg/dl). The clinical outcome was compared among these four groups.
Results: In this study majority were male patients (86%) with age ranging from 66-75 years (46%). About 85% of patients were smokers, and 15% were non-smokers. 68% of the study group population was hyperglycaemic (RBS >140 mg/dl). Among different quartiles, the mean length of stay in hospital was statistically considerable (p=<0.05), signifying an increased length of stay in hospital trend as the admission RBS levels increase. There was no statistically significant relationship amongst the RBS quartiles of ≤140 mg/dl and RBS quartiles of 141-170mg/dl (p=0.997). There was a statistically considerable correlation amongst the RBS quartiles ≤140 mg/dl and RBS quartiles ≥201 mg/dl(p=000), and this study’s crude rate of mortality was 5%. The population under quartile of RBS ≥201mg/dl had the highest percentage. All the people who died were over the age of 56 years. The mean HbA1c among dead (9.43 ± 2.25) and alive (6.78±1.70) showed significant relation (p=<0.05).
Conclusion: Higher the admission RBS, longer was the mean length of stay in hospital and mortality in the AECOPD diagnosed patients. Maintaining the blood glucose levels < 170 mg/dl than the strict glycaemic control, i.e.<140 mg/dl, could benefit these patients' outcome. This study indicates that for clinically treating the AECOPD patient population, targeted surveillance, as well as DM management, are critical.

A Hospital Based Prospective Study to Assess the Effectiveness of S/T Mode BIPAP and AVAPS Mode by Applying the Clinical and ABG Parameters at Admission and After 3 Hours and 6 Hours of Applying Non- Invasive Ventilation (NIV) in Management of Type-2 Respiratory Failure in AECOPD Patients in the Emergency Department/ICU

Suman, V.B. Singh, Deepak Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2261-2267

Background: Noninvasive ventilation (NIV) refers to the delivery of ventilatory support or positive pressure into the lungs without an invasive endotracheal airway, usually through a mask.The aim of this study to assess the effectiveness of S/T mode BIPAP and AVAPS mode by applying the clinical and ABG parameters at admission and after 3 hours and 6 hours of applying non- invasive ventilation (NIV) in management of type-2 respiratory failure in AECOPD patients in the emergency department/ICU.
Materials& Methods: A hospital based prospective study done on 50 patients with acute respiratory distress in ICU at SMS Medical College, Jaipur, Rajasthan, India during one year period. Patients were entered into the study if they were aged>18 yrs and had evidence of ARF as demonstrated by three of the following criteria: acute onset of moderate-to-severe dyspnoea as assessed by the ED physician who took care of the patient; a respiratory rate>30 (or<10) breaths/ min.; hypoxaemia (oxygen tension in arterial blood (Pa,O2) <7.3 kPa (55 mmHg) (on room air)) or need for O2 supplementation; respiratory acidosis (pH<7.33). 25 patients with acute exacerbations of COPD with GCS < 10 were designated to receive BiPAP S/T and 25 patients with acute exacerbations of COPD with GCS < 10 were designated to receive with AVAPS.Each patient was treated with NIV and was selected according to: APACHE II score within 4 points, age within 10 points, pH within 0.04, GCS within 2 points, and BMI within 2 points.
Results: The mean age of all patients was 78.72±11.43 years, mean APACHEII score was 18.47±2.55. There were no statistically significant differences between the two groups in terms of BMI, age, APACHEII score, or initial GCS score.The ANOVA analysis revealed statistically significant differences in favor of AVAPS for pCO2 (P <0.05*), respiratory rate (P<0.05*), maximum IPAP (P <0.05*), GCS score (P <0.001*) and ETV (P <0.05*). However,no significant differences were observed for length of stay (P >0.05) ordurationofNIV(P>0.05).

The Bacteriological profile and antibiotic sensitivity Pattern in AECOPD Patients

Dr.Aarif Khan, Dr.MazherMaqusood, Dr.Sudhir Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5082-5090

Aim: In light of the paucity of data on the bacteriological layout of AECOPD sufferer in
our country, the current study examined the layout of sputum bacteria and antibiotic
sensitivity in AECOPD hospitalized patients.
Material and methods: It was a prospective observational study conducted among 45
AECOPD patients diagnosed according to GOLD guideline (2019) in the department of
pulmonary medicine, TMMC & RC, Moradabad. Sputum sample was collected in the
morning before any meal & patient should not use oral antiseptics. After inoculating the
sample for 48 hours, inoculation culture plate with growth was identified on the basis of
culture characteristics, gram staining and biochemical reaction according to standard
guidelines.The antibiotic sensitivity of recovered isolates were determined by Kirby
Bauer disc diffusion method.
Results: The findings revealed that pseudomonas aeruginosa (42.2%) was the most
common isolated organism.It was sensitive to Cefepime (except one case),
Cefoperazone+Sulbactum, Ceftazidime (except one case), Meropenam (except two
cases), Colistin and Piperacillin+Tazobactum but resistant to Tigecycline and
Levofloxacin.Enterococcus species were sensitive and resistant to Linezolid and
Levofloxacin respectively. All the Escherichia coli cases were sensitive to Cefepime,
Cefoperazone+Sulbactum (except one case), Meropenam, Tigecycline, Colistin,
Piperacillin+Tazobactum but resistant to Ceftazidime and Levofloxacin.
Staphylococcus aureus were resistant to Levofloxacin and Linezolid.Staphylococcus
aureus (MRSA) was resistant to Levofloxacin and sensitive to Linezolid, Clindamycin
and Vancomycin.
Conclusion:Antibiotics must be prescribed depending on the bacterium susceptibility
profile found in the area. Prescribed patients with history for production of purulent
sputum is worth following the guidelines or protocol. It is high time to have a policy for
antibiotics usage at different levels- district, state and country to prevent the emergence
of MDR strains.