Oxygenation: Acute Exacerbated Chronic Obstructive Pulmonary Disease (AECOPD)

Pathophysiology/Etiology

Risk Factors

Labs/Diagnostics

Complications

Collaborative Treatment

Etiology: Tobacco exposure damages lung tissue and develops into COPD, unable to defend against infection

ABGs: PaCO2 >45 mmHg, PaO2 <55 mmHg, blood pH <7.35

Serum Biomarkers: Lactate, antitrypsin deficiency, C-reactive protein

Physical examination, oxygen saturation

Chest x-ray showing chest hyperinflation

Tobacco exposure

Risk increases with age

Prior exacerbation

Viral infection, C. Diff

Diabetes and hyperglycemia

DVT and PE

Hypercapnic respiratory failure (PaCO2 >50 mmHg, pH <7.3)

Repeat exacerbation -- further damage, higher mortality

Symptoms

Cough w/ sputum production

ECG showing diminished PR and ST intervals

Rapid worsening of baseline symptoms

Tachypnea & hypercapnia

Lethargic, altered LOC

Activity intolerance, DOE

O2 sat <94%

Acute at Presentation

Short-acting bronchodilator (albuterol)

Systemic corticosteroid (prednisone)

Airway clearance technique -- cough, turn, deep breath

Oxygen therapy to maintain O2 sat >94%

Interventions

Suction secretions

Avoid another exacerbation

Identify and avoid triggers

Noninvasive/invasive positive-pressure ventilation as indicated

Reduce exposure to infections

Antibiotics

Humidify room to loosen secretions

Pulmonary rehab

Assess readiness to learn and educate about chronic disease management

Encourage fluid intake

Semi-Fowler's

Small meals

Monitor for deterioration, prepare for intubation

IV fluids

Bedrest, cluster cares

Damaged lung tissue initiates local inflammatory response with cytokine and histamine activation. Excessive mucous production, increased airway muscle thickness and fibrosis of epithelial cells.

Chronic respiratory inflammation causes remodeling of cells in the airway and alveoli, becomes less resistant to irritants and more vulnerable to infection.

Shortness of breath

Infection triggers additional immune response surrounding respiratory tissue, further impairing ventilation through narrow bronchioles and gas exchange in inflamed alveoli. Cough, sputum, and SOB worsen.

Exacerbation of symptoms causes reduced systemic oxygenation and hypercapnia. Hypoxia causes activation of sympathetic nervous system, increasing cardiac output and respiratory response. Dyspnea causes anxiety, further exacerbating the feedback loop.

Compensatory system to oxygenate and perfuse tissue in response to hypoxia fail if adequate oxygen isn't delivered and respiratory failure occurs.

Cyanosis