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To determine if a regimen of intravenous and oral corticosteroids reduces the relapse rate after treatment of decompensated COPD in the ED, 30 patients were studied. Forty-five visits in which intravenous and oral corticosteroids were given (T visits) were compared with an equal number of matched visits in which they were withheld (N visits). No differences were noted between T and N visits with respect to clinical findings, laboratory results and other forms of therapy. Treatment with corticosteroids reduced the relapse rate within 24 h of discharge. At 48 h, the cumulative relapse rate for T visits (8.9 percent) was significantly lower than for N visits (33.3 percent; p = 0.005). For patients with a history of multiple relapses, a regimen consisting of intravenous and oral corticosteroids reduces the risk of relapse after ED treatment of decompensated COPD.

Fifty-five adult patients (5 women, 50 men) on chronic peritoneal dialysis, mostly continuous ambulatory peritoneal dialysis (CAPD), for 2 to 155 mon were asked whether or not they wanted to have mechanical cardiopulmonary resuscitation (CPR) in case of sudden death. Thirty-five patients (65%) opted for CPR and 20 (36%) declined. Statistically, sex (although the number of women interviewed was too small for a valid sample) and duration of dialysis had no effect on choice of CPR, whereas older age, the presence of diabetes, advanced medical disability, and advanced socioeconomic disability were associated with a tendency to decline CPR. Among the 10 patients who had CPR, 5 developed flail chest, 4 had multiple rib fractures, and only 1 had no chest wall trauma from CPR. Two patients left the hospital alive. One third of the patients on chronic peritoneal dialysis do not want CPR. Advanced age, diabetes, and poor medical and socioeconomic states predispose peritoneal dialysis patients to decline CPR.

This discussion was selected from the weekly Grand Rounds in the Department of Medicine, University of New Mexico School of Medicine, Albuquerque. Taken from a transcription, it has been edited by Ralph C. Williams, Jr, MD, Professor and Chair of the Department of Medicine.