Roorda, A. (2018) Een retrospectief cohortonderzoek naar het spontane herstel van unilaterale diafragma disfunctie: Hoe lang duurt het herstelproces en waardoor wordt het beïnvloed? thesis, Medicine.
Full text available on request.Abstract
Background To date, little is known about the spontaneous recovery of unilateral diaphragm dysfunction (UDD). The aim of the present study is to evaluate the recovery rate of UDD and to determine to what extent certain variables have an influence on the recovery time. This information may be usable for clinical decision making and informing patients about the prognosis of UDD. Methods A single-centre, retrospective cohort study with a maximum follow-up period of five years was conducted. The study consisted of two analyses. In the first analysis (n=69), spontaneous recovery was defined as an increase in vital capacity (VC) > 400 ml and in the second analysis (n=26), spontaneous recovery was defined as the absence of symptoms. The following possible predictive factors for the recovery time of UDD were registered: Age, gender, body mass index (BMI), etiology, comorbidities, VC at baseline and the decrease of VC in supine position (ΔVC) at baseline. The amount of respiratory related hospital admissions, pneumonias and the mortality rate were also obtained. Results Spontaneous recovery of the VC occurred after 6, 12, 24 and 60 months in 9,0% (95% CI 3,1-14,9), 26,0% (95% CI 16,2-35,8), 35,0% (95% CI 23,2-46,8) and 64,0% (95% CI 48,3-79,7) of the patients respectively. Furthermore, spontaneous recovery of the symptoms occurred after 6, 12, 24 and 60 months in 0,0% (95% CI 0,0-0,0), 20,0% (95% CI 4,3-35,7), 54,0% (95% CI 32,4-75,6) and 73,0% (95% CI 51,4-94,6) of the patients respectively. Patients with a traumatic etiology had a significant faster recovery of the VC compared to other specified etiologies (HR 4,08; 95% CI 1,18-14,14) and idiopathic UDD (HR 5,47; 95% CI 2,47-12,13). No predictive factors were found for the recovery time of the symptoms. Pneumonias and respiratory related hospital admissions were observed in respectively 24,3% and 29,7% of the patients. The mortality within the study population was 14,9%. Conclusion The present study indicates that spontaneous recovery may occur years after the onset of UDD. The etiology is a predictive factor for the recovery time of the VC, as patients with a traumatic etiology recover significantly faster. No predictive factors were found for the recovery time of the symptoms. Additionally, this study suggests that the recovery of UDD is often complicated by pneumonias and respiratory related hospital admissions.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Eijsvogel, Drs. M.M.M. longarts and Uitgevoerd op de afdeling Longgeneeskunde in het Medisch Spe |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/658 |
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