WCIM 2014 SEOUL KOREA 211
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0632 Respiratory Medicine
Association Between Blood Levels of Heavy Metals and Lung Function in a Cohort of Chronic Obstructive Pulmonary Disease
Hyun-Sun PARK1, Woo Jin KIM1, Seon-Sook HAN1, Yoon Ki HONG1, Myoung-Nam LIM1
Kangwon National University Hospital, Korea1
Background: Heavy metal exposure, either through occupational exposure, cigarette smoking, or air pollution, is a risk factor for various pulmonary diseases. Heavy metals such as mercury, cadmium, and chromium have been reported to be associated with oxidative stress and infl ammation in the lung. This study was performed to evaluate the association between blood levels of heavy metals and lung function in a cohort of chronic obstructive pulmonary disease (COPD) patients and controls.
Methods: We used the data of 152 subjects enrolled from 2012 to 2013 extracted from a cohort study of chronic obstructive pulmonary disease (COPD) in dusty areas.
COPD was defi ned as a post-bronchodilator FEV1/FVC value of less than 0.7. Blood mercury and cadmium levels were measured by an anatomic absorption spectropho- tometer. Chromium levels were measured using an inductively coupled plasma mass spectrometry (ICP-MS).
Results: The 111 COPD subjects and 41 control subjects were evaluated. The COPD and control group showed no signifi cant differences in blood mercury, cadmium, and chromium levels. Blood levels of cadmium and chromium were not associated with lung function after the adjustment for gender, age, and smoking amount. The blood mercury level was signifi cantly associated with the post-bronchodilator FEV1 (p value
= 0.03).
Conclusions: Blood levels of mercury, cadmium, and chromium were not associated with the COPD status. However, the blood mercury level was signifi cantly associated with the post-bronchodilator FEV1 in a cohort study of COPD subjects in dusty areas.
PS 0633 Respiratory Medicine
COPD and Percutaneous Coronary Intervention.
PAVEL ALEXEI CHISHOLM SÁNCHEZ1, JAVIER DE MIGUEL DÍEZ2, DIEGO JOSÉ CASTRILLÓN RODRÍGUEZ1, RODRIGO JIMÉNEZ GARCÍA3, VALENTÍN HERNÁNDEZ BARRERA3, PILAR CARRASCO GARRIDO3, ANA LÓPEZ DE ANDRÉS3
Interanl Medicine, Hospital General Universitario Gregorio Marañón, Spain1, Respiratory Medicine, Hos- pital General Universitario Gregorio Marañón, Spain2 Universidad Rey Juan Carlos, Spain3
Background: To compare trends in the use and outcomes of PCI in patients COPD and non COPD patients in Spain from 2001 to 2011.
Methods: We identifi ed all patients who had undergone PCI, using national hospital discharge data. Discharges were divided, according to history of COPD, in 2 groups:
COPD and non COPD. The incidence of discharges attributed to percutaneous coronary intervention were calculated and stratifi ed by COPD status. We calculated comorbidity Charlson Comorbidity Index (CCI), length of stay (LOS) and in-hospital mortality (IHM).
Results: From 2001 to 2011, 434,108 PCI´s were performed. The incidence of use of PCI increased over time in both groups (p<0.05), COPD and non COPD, from 4.94 per 100,000 inhabitants in 2001 to 11.76 in 2011 in COPD, and from 87.74 to 177.56 in non COPD. Comorbidity increased signifi cantly in both groups (p<0.05). The average LOS decreased signifi cantly over time, from 9 (IQR 10) days in 2001 to 6 (IQR 6) days in COPD patients, and from 6 (IQR 9) days in 2001 to 5 (IQR 6) days in patients with- out COPD. IHM changed signifi cantly over the entire study period among patients with COPD (from 2.65% in 2001 to 2.66% in 2011, p<0,05, x2 linear trend analysis) and non COPD (from 1.92% in 2001 to 1.85% in 2011, p<0,05, x2 linear trend analysis).
Conclusions: The incidence of use of PCI procedures increased over time in COPD and non COPD patients. Increasing comorbidity can be associated with a higher use of PCI procedures. LOS and IHM were higher in patients with COPD than in those without this disease.
PS 0634 Respiratory Medicine
High Flow Nasal Cannula Can Be Suitable Method in Patients with Post-Extubation
Dae Sung KIM1, Sun Jung KWON1, Moon Jun NA1, Ji Woong SON1, Oh Jung KWON1, Sun Hee OH1
Konyang University Hosptial, Korea1
Background: Reintubation is associated with increased mortality. In the previous study, reintubation is a consequence of respiratory failure after extubation and occurs in 16% within 48 hours after planned extubation. Non-invasive ventilation (NIV) is a supportive therapy that improves mortality in acute respiratory failure. Applying high fl ow nasal cannula (HFNC) can be immediately an alternative method in place of non- invasive respiratory support in patients with postextbation. However, the benefi t of the use of HFNC after extubation was not clear.
Methods: We conducted study retrospectively to examine whether HFNC can reduce the risk of reintubation in patients after extubation in the ICUs. A total of 62 extu- bated patients who received treatment with HFNC were included in the analysis from Nov. 2011 to Jul. 2014. Patients were liberated from mechanical ventilation using daily spontaneous breathing trail. We set HFNC as follows. Flow rate was 30~60L/min and fraction of inspired oxygen (FiO2) could retain peripheral capillary oxygen saturation (SpO2) above 90% and pressure of oxygen in arterial blood (PaO2) above 60mmHg.
We checked clinical parameters and arterial blood gas analysis after extubation. The primary outcome was the rate of reintubation after extubation.
Results: The median duration of mechanical ventilation was 158 hours and median PaO2/FiO2 ratio on time of ventilator weaning day was 246.4 mmHg. Six patients (9.7%) were required reintubation. Three patients (4.8%) and three patients (4.8%) were required reintubation within 48 hours and after 48 hours after extubation. The median time from extubation to reintubation was 72.5 hours.
Conclusions: The use of HFNC as respiratory support after extubation in ICU patient was effective method for preventing reintubation.
PS 0635 Respiratory Medicine
A Survey of Practice Patterns of Medical Residents on the Use of Non-Invasive Ventilation at Philippine Gen- eral Hospital
Gian Carlo CARPIO1, Roy BALLASO1, Gene AMBROSIO1 Philippine General Hospital, Philippines1
Background: Provision of non-invasive ventilation (NIV) among selected patients with respiratory failure remained challenging to clinicians. There is limited data regarding clinical and technical utilization locally especially among medical residents.
Objective: The purpose of this study is to determine the practice patterns of medical residents on the use of non-invasive ventilation in a tertiary care hospital.
Methods: Descriptive survey involving 56 participants.
Results: Majority of participants have attended NIV lectures, but only few have joined hands-on workshop. None of them knew any existing guideline about NIV. Majority of respondents have practiced NIV (60.71%). Overall utilization rate was low and <
10% of all mechanical ventilation. High cost of equipment rental (81.82%) and lack of knowledge were identifi ed as major barriers to NIV use. Top clinical indications include COPD exacerbation (100%) and respiratory failure in do-not-intubate patient (52.9%).
Majority of participants will monitor response after 1 hour (55.9%). Face mask was the preferred interface (94%) irrespective of clinical scenario. ICU ventilator with NIV module was frequently used both for COPD and ACPE. Bi-level mode ventilation (76%) was more frequently used than CPAP. All medical residents agreed to stop NIV and proceed to intubation in the presence of respiratory pause or arrest and poorly toler- ated cardiac arrhythmia. Practical and academic teaching and network organization for NIV were highly suggested.
Conclusions: Majority of study participants have acceptable NIV practices. Signifi - cant variability of practice patterns exists in terms of preferred site of initiation and protocol for initiation followed. NIV protocol should be created based on latest inter- national guideline that is best applicable locally. Special ad hoc committee should be formed locally to negotiate high cost of equipment rental and make NIV easily availa- ble to most indigent patients.
