EBM PICO

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EBM - PICO

• R1 ???

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Basic data

• Name ???
• Sex male
• Age 77 y/o
• Chart No 20419360
• Admission date 97 / 5 / 22

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Chief complain

• Acute onset of shortness of breath
• for one day.

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Present illness

• This 75 y/o male had past history of (1)COPD for
  2-3 years, (2)Hypertension with Norvasc control,
  (3)BPH (4)lumber spine (L1 ) compression fracture.

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Present illness

• He was a heavy smoker. He had COPD with acute
  exacerbation for several times in recent years.
• The pulmonary function test (97/02/04)) showed
  very severely obstructive ventilatory
  impairment..

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• He was just discharge from our ward due to
  chronic obstructive pulmonary disease with acute
  exacerbation on 97/05/20.
• He had mild cough with whitish sputum in
• recent days. Shortness of breath was noted
  since last night, accompanied with wheezing.
• He also complained of nasal congestion and
  sore throat currently.
• There was no fever, no chillness, no chest
• pain, no hemoptysis, and no travel history.

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• Due to the discomfort, he went to our ER. The
  laboratory data showed leukocytosis with left
  shift and CXR showed emphysematous change over
  bilateral lower lung. No active infection or
  infiltration process could be seen.
• Under the impression of chronic obstructive
  pulmonary disease with acute exacerbation, he was
  admitted for further survey and treatment.

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Past / Personal history

• Medical history
• recurrent COPD with acute exacerbation and
  secondary infection
• Smoking1 PPD for 50 years, quit for 2 years
• Alcoholic drinkingdenied
• Betel nutdenied
• Travel history denied

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97/5/21 ER
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97/5/21 ER
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PICO

• P patient with exacerbations of chronic
• obstructive pulmonary disease
• I using antibiotics
• C without antibiotics
• O Outcome (hospital day, mortality)

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(No Transcript)
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Result

• Search Results 9

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• Antibiotics for exacerbations of chronic
  obstructive pulmonary disease
• (Review)
• Ram FSF, Rodriguez-Roisin R, Granados-Navarrete
  A, Garcia-Aymerich J, Barnes NC

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Background

• For decades, there is an unresolved debate about
  adequate prescription of antibiotics for patients
  suffering from exacerbations of chronic
  obstructive pulmonary disease (COPD).
• The aim of this systematic review was to analyse
  randomised controlled trials investigating the
  clinical benefit of antibiotics for COPD
  exacerbations.

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Search strategy

• Searched the
• 1.Cochrane Central Register of Controlled Trials
• (The Cochrane Library Issue 4, 2005)
• 2.MEDLINE (1966 to December 2005)
• 3.EMBASE (1974 to December 2005)
• 4.Web of Science (December 2005)

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Search strategy

• Systematic review of randomised,
  placebo-controlled trials assessing the effects
  of antibiotics on clinically relevant outcomes in
  patients with an exacerbation.

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Main results

• Eleven trials with 917 patients were included.
  Ten trials used increased cough, sputum volume
  and purulence diagnostic criteria for COPD
  exacerbation.
• It provided data for outcomes including
  mortality, treatment failure, increased sputum
  volume, sputum purulence, PaCO2, PaO2, peak flow
  and adverse events.

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Main results

• Antibiotic therapy regardless of antibiotic
  choice significantly reduced mortality, treatment
  failure and sputum purulence .
• Antibiotics did not improve arterial blood gases
  and peak flow.

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Conclusion

• Antibiotics effectively reduce treatment failure
  and mortality rates in COPD patients with severe
  exacerbations.
• For patients with mild to moderate
  exacerbations, antibiotics may not be generally
  indicated.
• Further research is needed to guide antibiotic
  prescription in these patients.

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Mortality
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Treatment failure
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Sputum purulence
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Short-term mortality
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Hospital days