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Acute exacerbation of COPD (Cause (Infection (50%), HF (25%)), Management…
Acute exacerbation of COPD
Cause
Infection (50%)
HF (25%)
Management
Ventilatory support
NIV
Indicated if acute resp acidosis has failed to respond to optimal medical therapy
Early intervention if RR>30 and pH<7.35
Good evidence - Cochrane review (reduced mortality and less need for invasive vent)
If CI consider intubation
Intubation
Prior to invasive treatment consider: age, severity of COPD, presence of reversible component, functional status
Medical treatments
Bronchodialtors (salbutamol 5mg neb = 8-10 puffs with spacer, Ipatropium 500mcg). Interval titrated to response: can range from 1-6 hourly
Supplemental 02 (nasal prongs 0.5-2l/min, aim sats 88-92)
Corticosteroids - Pred 50mg for up to 2/52
Abx - if features of infective exacerbation (fever, increased volume/colour sputum)
Advanced care directives - careful assessment of pre-morbid functional state and patient wishes
Post ICU care
Optimisation
Stop smoking
Additional inhaled bronchodilators +/-corticosteroid
Pulmonary rehab programs - improve exercise capacity and QOL and reduce admissions
Influenza and pneumococcal vaccines
Consideration of surgery for a select popn of those with advanced disease (palliative-nil improvement to survival)
Home 02 therapy - at least 15hrs per day, improve mort in hypoxaemic patients (presumably via reduced pulm HTN)