Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7396.956 (Published 03 May 2003) Cite this as: BMJ 2003;326:956
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EDITOR-We would like to comment the paper by Plant et al. recently
published on BMJ with our own data obtained in a newly opened 4 beds
cardio-respiratoty unit, located in our geriatric ward (Poliambulanza
Hospital, Brescia, Italy), with 2 beds dedicated to non invasive
ventilation.
In the first 3 months, from the group of 30 patients admitted to the
Emergency Department (ED) for acute exacerbations of chronic obstructive
pulmonary disease needing “intensive treatment”, one was admitted to
intensive care unit (ICU) and 29 (age 76.1+8.1 years; LOS 8.1+3 days;
APACHE II score: 21.9+7.5; pH: 7.25+0.09; Charlson Index: 7.4+1.4) were
transferred to our ward and non-invasively ventilated. None of them
furtherly needed to be transferred for intubation in ICU.
We compare these data with those obtained in 30 patients, with a
comparable age and severity of disease, admitted to the ED for the same
clinical condition (i.e. needing respiratory “intensive treatment”)
before the realization of the “non invasive ventilated beds”. In this
group 4 patients were directly admitted to the ICU, while the others have
been ventilated in the ED (n=16) or transferred in normal medical ward
(n=10). Of them 2 had to be re-transferred in the intensive care unit.
We are aware that the small number of our sample does not allow
general conclusions, but we would like to stress the agreement with Plant
et als’ data, althought in a different population and in a completely
different hospital organization. We will perform in the next future a more
accurate and large analysis of cost effectiveness of our beds with non
invasive ventilation.
Competing interests:
None declared
Competing interests: No competing interests
Transenteral and peritoneal oxygenation
We have shown in pigs that delivering oxygen through the lumen of
some two thirds of the small intestine prevented the compensatory increase
in cardiac output in experimentally induced severe hypoxaemia (1). Judging
from the magnitude of the reduction in cardiac output achieved the amount
of oxygen delivered was equal to about 25% of that delivered in blood in
normoxia. The transenteric delivery of oxygen, and removal of CO2, was
accomapnied by a rise in both portal venous and systemic pO2.
Shozo Baba, professor of surgery at Hammamatsu in Japan, has obtained
similar results with a small animal model using intraperitoneal infusions
of oxygenated perflurocarbonemulsions. These emulsions are safe, having
been successfully used for transbronchial oxygenation and coronary artery
perfusion.
I have proposed to clinical investigators in India and South Africa
that enteric lavage with oxygenated perfluorocarbon emulsions might
provide a simple, safe and cost-effective method for oxygenating patients
in lesser developed countries.
1. Gross BD, Sacristan E, Peura RA, Shahnarian A, Devereaux D, Wang
HL, Fiddian-Green R. Supplemental systemic oxygen support using an
intestinal intraluminal membrane oxygenator. Artif Organs. 2000
Nov;24(11):864-9.
Competing interests:
None declared
Competing interests: No competing interests