1. Positive Expiratory Pressure Therapy With And Without Oscillation And Hospital Length Of Stay For Acute Exacerbation Of Chronic Obstructive Pulmonary Disease
- Author
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Praveen Bondalapati, Michael Megally, Liam Gross, Jeremy A. Weingarten, Puja Chadha, Elizabeth M Bachman, Pramil Vaghasia, Eshan Patel, and Stephen Milan
- Subjects
Male ,medicine.medical_specialty ,Acute exacerbation of chronic obstructive pulmonary disease ,Time Factors ,Length of hospitalization ,International Journal of Chronic Obstructive Pulmonary Disease ,Positive expiratory pressure ,law.invention ,Positive-Pressure Respiration ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,length of stay ,law ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Original Research ,COPD ,Ventilators, Mechanical ,business.industry ,Retrospective cohort study ,Equipment Design ,Recovery of Function ,General Medicine ,Middle Aged ,PEP therapy ,medicine.disease ,acute exacerbation of COPD ,Clinical trial ,Treatment Outcome ,030228 respiratory system ,PEP ,Disease Progression ,Female ,business ,hospitalization - Abstract
Stephen Milan, Praveen Bondalapati, Michael Megally, Eshan Patel, Pramil Vaghasia, Liam Gross, Elizabeth M Bachman, Puja Chadha, Jeremy A Weingarten Weill Cornell Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USACorrespondence: Jeremy A WeingartenWeill Cornell Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY 11215, USATel +1 718 780 5835Fax +1 718 780 5836Email jaw9031@nyp.orgIntroduction: Pharmacologic management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is well-established. Our aim in the current study is to determine if therapy with a positive expiratory pressure (PEP) device with or without an oscillatory mechanism (OM) in addition to standard care results in a reduction in hospital length of stay (LOS) among patients hospitalized for AECOPD.Methods: Two studies were performed and are reported here. Study 1: Patients admitted with AECOPD and sputum production were enrolled in a prospective trial comparing PEP therapy versus Oscillatory PEP (OPEP) therapy. Study 2: A retrospective historical cohort, matched in a 2 to 1 manner by age, gender, and season of admission, was compared with the prospectively collected data to determine the effect of PEP ± OM versus standard care on hospital LOS.Results: In the prospective trial (Study 1; 91 subjects), median hospital LOS was 3.2 (95% CI 3.0–4.3) days in the OPEP group and 4.8 (95% CI 3.9–6.1) days in the PEP group (p=0.16). In fully adjusted models comparing the prospective trial data with the retrospective cohort (Study 2; 182 subjects), cases had a median hospital LOS of 4.2 days (95% CI 3.8–5.1) versus 5.2 days (95% CI 4.4–6.0) in controls, consistent with a shorter hospital LOS with adjunctive PEP±OM therapy versus standard care (p=0.04).Conclusion: Adjunctive therapy with a PEP device versus standard care may reduce hospital LOS in patients admitted for AECOPD. Although the addition of an OM component to PEP therapy suggests a further reduction in hospital LOS, comprehensive multicenter randomized controlled trials are needed to confirm these findings.Clinical trial registration number: NCT03094806.Keywords: length of stay, acute exacerbation of COPD, PEP, hospitalization
- Published
- 2019