hospice guidelines for determining prognosis, pulmonary disease

Guidelines: 1) severity of chronic lung disease, documented by a) disabling dyspnea at rest, poorly responsive to bronchodilators b) FEV1 of < 30% of predicted (after bronchodilator) or a decrease in FEV1 of > 40 mL/year c) increasing visits to Emergency Department or hospitalizations 2) right heart failure (cor pulmonale) due to pulmonary disease - documented by 1] echocardiogram 2] electrocardiogram 3] chest X-ray 4] physical signs of right heart failure 3) hypoxemia at rest on supplemental oxygen a) paO₂ =< 55 mm Hg on supplemental oxygen b) O₂ saturation =< 88% on supplemental oxygen 4) hypercapnia: pCO₂ > 50 mm Hg 5) unintentional, progressive weight loss of > 10% body weight over preceding 6 months 6) resting tachycardia > 100/min

References

Medical Guidelines for Determining Prognosis in non-Cancer Diseases, 2nd edition, Stuart et al (eds), National Hospice Organization, Arlington, VA, 1996