Managing Acute Respiratory Failure During Exacerbation of Chronic Obstructive Pulmonary Disease

The full text article is not available for purchase.

The publisher only permits individual articles to be downloaded by subscribers.

Abstract:

Exacerbations of chronic obstructive pulmonary disease (COPD) are a major health problem, causing more than half a million hospital admissions per year in the United States. Although overall mortality is low, it is substantially higher with severe exacerbations that require intensive care and mechanical ventilation. The majority of COPD exacerbations result from infection, with typical bacterial organisms most commonly identified. Numerous randomized controlled trials and meta-analyses have documented the benefits of antibiotics, low-flow oxygen, and systemic corticosteroids, and the therapeutic equivalency of the major classes of bronchodilators (short-acting β-agonist and anticholinergics). Randomized controlled trials also demonstrate that noninvasive ventilation can decrease the incidence of intubation, shorten stay, reduce infectious complications, and improve survival. Although patients who require intubation have the worst prognosis, the vast majority of them can be successfully liberated from mechanical ventilation. For invasively ventilated patients the clinical emphasis should be on improving patient-ventilator interaction and avoiding dynamic hyperinflation (intrinsic positive end-expiratory pressure).

Keywords: BRONCHODILATOR; CHRONIC OBSTRUCTIVE PULMONARY DISEASE; COPD; CORTICOSTEROID; EVIDENCE-BASED MEDICINE; MECHANICAL VENTILATION; OXYGEN THERAPY; RESPIRATORY FAILURE

Document Type: Research Article

Affiliations: 1: Pulmonary, Critical Care, and Sleep Division, Tufts – New England Medical Center, Boston, Massachusetts 2: Department of Medicine, Caritas-St Elizabeth's Medical Center, and Tufts University School of Medicine, 736 Cambridge Street, Boston MA 02135;, Email: scott.epstein@tufts.edu

Publication date: July 1, 2004

More about this publication?
Related content

Tools

Favourites

Share Content

Access Key

Free Content
Free content
New Content
New content
Open Access Content
Open access content
Subscribed Content
Subscribed content
Free Trial Content
Free trial content
Cookie Policy
X
Cookie Policy
ingentaconnect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more