CAOS – The COPD & Asthma outcome study (2009) – an oldie, but interesting…

original paper is here

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I am a single speciality Intensive care Medicine trainee and member of the Intensive Care Society Council... originally from Ireland but trained and working in West Mids, UK. You say my name like ee-fa My notes are not medical advice. Please enjoy, comment, share and let me know your thoughts. Disclaimers: All my opinions are generally a work in progress and therefore subject to change - but then why would it be any other way? Views expressed on Whistlingdixie and Scribblingdixie blogs are not medical advice. My opinions and the content on either of these sites do not constitute the opinion of any of my employers, The Intensive Care Society or any other organisation I may be affiliated with.

2 thoughts on “CAOS – The COPD & Asthma outcome study (2009) – an oldie, but interesting…

  1. great work. How do they decided “not to intubate”? Eventhough they did a prospective work, they did not “intervine” in any way. It would help to know it they decided that with the family, only the MD, etc. Another interesting fact would be to include frailty as a predictor (http://camapcanada.ca/Frailtyscale.pdf)
    Anyhow, it does emphasize that we should not assume that our idea of QoL is equal to the patients, and we should always include them in the equation.
    keep it up!

    Also, free full text with final format: https://thorax.bmj.com/content/thoraxjnl/64/2/128.full.pdf

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    1. Thanks – agree totally. It was my understanding that the decision with respect to admission and ‘not for’ intubation were made according to local preferences/assessments without interference from the study….which was conducted across a large number of UK centres. I think frailty would be a really interesting thing to look at – especially given the results of the VIP study (ICM journal, there’s a post on here) which I thinks shows real promise for helping with these admission decisions, particularly as patients don’t really have just one comorbidity, commonly, in my experience anyway.
      I think for the me the thing I take from this study is less about the concept of who I should admit (because all these patients were pre-selected for ITU, so they were already decided as for admission and we don’t know about those who stayed on the ward in those hospitals) but more about what you say yourself… that when a patient with COPD is intubated on the ITU and we get the ‘oh I will never get them off the ventilator’ feeling – perhaps we can remind ourselves of the evidence that although the mortality in this study was about 50% that the majority of those who survived were subjectively back to their baseline health and would consent to the process again … which is often the worry isn’t it? what would the patient say they wanted, if they were well enough to be engaged etc – because with the best will in the world, the evidence suggests that sometimes the family just don’t know or can (without malice or intent) portray their on ideals instead… just like we as intensive care teams can be prone to do too.
      Well that’s what I take from it anyway 🙂

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