New research was presented at ATS 2015, the American Thoracic Society’s annual meeting, from May 15 to 20 in Denver. The features below highlight some of the studies that emerged from the conference.
Predicting COPD Exacerbation Readmissions
The Particulars: Previous studies have found that the 30-day readmission rate following an acute exacerbation of COPD (AECOPD) can be as high as 23%. However, predictors of readmission after AECOPD have not been well established in clinical investigations.
Data Breakdown: For a study, researchers used univariate analysis to identify predictors of 30-day readmission among patients hospitalized with a primary diagnosis of AECOPD. The authors found that low forced ejection fraction in 1 second (FEV1) and a history of depression independently predicted 30-day readmission.
Take Home Pearl: Depression and low FEV1 appear to predict 30-day readmission following hospitalizations for AECOPD.
E-Cigarette Use in Older Adults
The Particulars: Electronic cigarettes (e-cigarettes) are increasingly being used by smokers. However, data are lacking on the use of e-cigarettes in older Americans, those with smoking-related lung disease, or ethnic minorities.
Data Breakdown: Researchers assessed e-cigarette use among more than 10,000 Caucasian and African-American current and former smokers with at least 10-pack years. Those who had tried e-cigarettes were significantly more likely to be current smokers, compared with those who had not. About 91% of e-cigarette users reported using them to cut down on tobacco cigarette use, but only 47% did so. COPD exacerbation and chronic bronchitis rates were similar among e-cigarette users and non-users.
Take Home Pearl: E-cigarette use does not appear to reduce tobacco cigarette use or alter the progression of COPD.
Detecting Lung Changes During AECOPD Hospitalization
The Particulars: Characterizing proteome changes during an acute exacerbation of COPD (AECOPD) could guide treatment during hospitalization. However, few studies have assessed changes in the expression of biomarkers in the lungs of AECOPD patients during their hospitalization.
Data Breakdown: Sputum samples were collected prior to treatment and at discharge for patients hospitalized for severe AECOPD for a study. These data were then compared using antibody microarray analyses. The expression of 12 cytokines that were up-regulated at the onset of exacerbation exhibited a significant decrease upon treatment.
Take Home Pearls: Antibody microarray analysis of sputum appears to characterize changes in the lung proteome of patients hospitalized for AECOPD. Understanding these changes could help guide personalized medicine.
Persistent Air Leaks After LVRS
The Particulars: Previous research shows that lung volume reduction surgery (LVRS) can be efficacious in select patients with advanced emphysema. However, 45% of patients may experience prolonged postoperative air leaks after LVRS. Little is known about the long-term effects of prolonged post-LVRS air leaks on surgical mortality or forced expiratory volume in 1 second (FEV1) at 1 year.
Data Breakdown: For a study, researchers compared FEV1 levels at 1 year and examined 6-month mortality among LVRS patients who had prolonged postoperative air leaks or no such leaks. No mortalities were observed in either patient group. From baseline, FEV1 improved by about 38% for all patients. No significant differences were seen between those with and without prolonged postoperative air leaks.
Take Home Pearl: Persistent postoperative air leaks do not appear to affect mortality or impact improvements in FEV1 following LVRS.
AF in Recent Lung Transplant Recipients
The Particulars: Studies have found that 20% to 40% of lung transplant recipients experience postoperative early atrial fibrillation (AF), and this complication can have varied effects on mortality. However, risk factors for early AF and its impact on outcomes in this patient population are not well known.
Data Breakdown: Among lung transplant recipients participating in a study, researchers found that men, older patients, those with high BMIs, prior smokers, and individuals with a history of coronary artery disease, hypertension, or prior AF were more likely to develop early AF. Those with early AF had longer hospital and ICU stays, a significantly higher mortality rate, and higher rates of ICU readmission, re-intubation, tracheostomy, and late AF.
Take Home Pearl: Lung transplant recipients who develop early AF appear to experience longer hospitalizations and have higher morbidity and mortality rates.
Early Surgery Benefits Infective Endocarditis Patients
The Particulars: Few studies have assessed the effect of early valve surgery on mortality in patients with infective endocarditis. The studies that have been completed have yielded inconclusive results.
Data Breakdown: Study investigators conducted a meta-analysis to compare all-cause mortality in patients treated with early surgery or conventional medical therapy for infective endocarditis. Across 20 studies, patients who underwent early surgery had significantly lower all-cause mortality when compared with those who received conventional therapy.
Take Home Pearl: Early valve surgery for infective endocarditis appears to significantly reduce all-cause mortality when compared with conventional therapy.
Analyzing ED Physician Disagreements With Pneumonia Guidelines
The Particulars: Data indicate that adherence to practice guidelines for pneumonia remains low despite evidence that following them improves outcomes. Measuring disagreement among emergency physicians with triage and antibiotic selection recommendations for managing pneumonia may improve guideline adherence.
Data Breakdown: In a study, researchers found that ED physicians disagreed with triage recommendations in 16% of pneumonia cases over the course of 1 year. Physicians most commonly cited medication allergy and previous failure with antibiotics as their rationale for disagreeing with antibiotic recommendations.
Take Home Pearl: ED physicians appear to commonly disagree with pneumonia guidelines for various reasons, highlighting the need for educational efforts on triage and antibiotic selection.
Holiday & Weekend Admission to ICUs From EDs
The Particulars: Patients are often more likely to be admitted to hospitals on week days and have better outcomes than those admitted on weekends. Little is known if these trends apply to ICU admissions.
Data Breakdown: For a study, researchers reviewed data for adult patients admitted directly from EDs to ICUs on major holidays, 2 days before and after holidays, and 1 week before and after holidays. The rate of ICU admissions directly from the ED did not differ among the various time periods. However, patients admitted during holidays were more likely to die than those admitted at other times (odds ratio, 4.6).
Take Home Pearls: ICU admissions directly to EDs do not appear to differ between holidays and other days. However, patients admitted directly from EDs to ICUs on holidays appear to have a higher mortality risk.
Bundled Approach to Sepsis Improves Outcomes
The Particulars: In previous research, investigators developed a bundled intervention designed to improve recognition and treatment of adults with severe sepsis in the first 6 hours after presentation. The bundle involved sepsis triage screening and a sepsis admission alert to expedite ICU admission processes from the ED.
Data Breakdown: During the 3 months following implementation of the intervention, ED length of stay (LOS) decreased by 1 hour and hospital LOS decreased by 24 hours. When compared with pre-intervention data, 21% more ICU patients were discharged home, and 14% fewer cases were transferred to a skilled nursing facility.
Take Home Pearl: A bundled approach to identifying sepsis and caring for it appears to decrease ED and hospital LOS. It also improved rates of patients being discharged home and streamlined the identification process.
Readings & Resources (click to view)
For more information on these studies and others that were presented at ATS 2015, visit http://conference.thoracic.org/2015/attendees/ats-2015-in-denver.