Fuhrmann Verena, Wandl Bettina, Laggner Anton N, Roth Dominik
Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Wien, Austria.
Institute of Nursing Science, Department of Nursing Science and Gerontology, UMIT TIROL-Private University for Health Sciences and Health Technology, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tyrol, Austria.
Healthcare (Basel). 2024 Mar 12;12(6):637. doi: 10.3390/healthcare12060637.
This study compared the treatment outcomes of acute exacerbation of COPD (AECOPD) at an academic tertiary care emergency department before and during the COVID-19 pandemic. Analyzing data from 976 patients, our study showed a significant surge in overall respiratory therapy interventions amidst the noticeable decline in the total number of AECOPD cases during the pandemic. The marked increase in the utilization of non-invasive ventilation (NIV) was particularly important, soaring from 12% to 18% during the pandemic. Interestingly, this heightened reliance on NIV stood in contrast to the stability observed in other therapeutic modalities, including oxygen insufflation alone, high-flow nasal cannulas, and invasive ventilation. This distinctive treatment pattern underscores the adaptability of healthcare providers in the face of novel challenges, with a discernible emphasis on the strategic utilization of NIV. The shift in patient acuity during the pandemic became evident as the data showed a cohort of individuals presenting with AECOPD who were more severely ill. This was reflected in the increased use of NIV and, notably, a statistically significant rise in one-year mortality rates-from 32% before the pandemic to 38% during the pandemic ( = 0.046). These findings underscore the intricate balance healthcare providers must strike in navigating the complexities of patient care during a public health crisis. A closer examination of the longitudinal trajectory revealed a subtle decrease in re-admission rates from 65% to 60%. The increased reliance on NIV, a key finding of this investigation, reflects a strategic response to the unique demands of the pandemic, potentially influenced by both medical considerations and non-medical factors, such as the prevalent "fear of aerosols" and the imperative to navigate transmission risks within the healthcare setting. These insights contribute to understanding the evolving dynamics of AECOPD management during public health crises.
本研究比较了COVID-19大流行之前和期间，一所学术型三级护理急诊科中慢性阻塞性肺疾病急性加重（AECOPD）的治疗结果。通过分析976例患者的数据，我们的研究表明，在大流行期间AECOPD病例总数显著下降的情况下，整体呼吸治疗干预措施却大幅增加。无创通气（NIV）使用的显著增加尤为重要，在大流行期间从12%飙升至18%。有趣的是，这种对NIV的更高依赖与其他治疗方式的稳定性形成对比，其他治疗方式包括单纯吸氧、高流量鼻导管吸氧和有创通气。这种独特的治疗模式凸显了医疗服务提供者面对新挑战时的适应性，明显强调了NIV的策略性使用。大流行期间患者病情严重程度的变化变得明显，数据显示一组患有AECOPD的患者病情更严重。这体现在NIV使用的增加上，值得注意的是，一年死亡率在统计学上显著上升——从大流行前的32%升至大流行期间的38%（P = 0.046）。这些发现强调了医疗服务提供者在公共卫生危机期间应对患者护理复杂性时必须把握的微妙平衡。对纵向轨迹的进一步检查显示再入院率从65%略有下降至60%。本研究的一项关键发现是对NIV的依赖增加，这反映了对大流行独特需求的策略性应对，可能受到医学考量和非医学因素的影响，如普遍存在的“气溶胶恐惧”以及在医疗机构内应对传播风险的必要性。这些见解有助于理解公共卫生危机期间AECOPD管理的动态变化。
