How Should Exacerbations of COPD Be Managed in the Intensive Care Unit? • Bronchodilators, including b2-adrenergic agonists and anticholinergics, remain the mainstay of therapy for patients with acute exacerbation of COPD. • In most cases, a course of corticosteroids, not exceeding 14 days, is indicated. • Theophylline is not currently supported by best evidence. • Although the use of antibiotics is controversial, the development of respiratory failure of sufficient severity to warrant intensive care admission is an indication for antimicrobial therapy. • Oxygen therapy should be titrated against blood gases, aiming at normalizing PaO2. • Noninvasive ventilation is an effective intervention for severe hypercarbic respiratory failure. If NIPPV fails, mechanical ventilation should be considered. • Ventilatory strategy in COPD should focus on delivering adequate flow to match patient demands while minimizing the development of auto-PEEP. • During mechanical ventilation, PaCO2 should be targeted at the patient’s normal range rather than “normal levels.” Normalization of PaCO2 will result in significant metabolic alkalosis. • The time on mechanical ventilation should be a short as possible; consideration should be given to extubation of the patient to NIPPV. • Prognosis for patients admitted to the ICU with exacerbations of COPD is overall very good, and admission is warranted in most cases, dependent on patients wishes and advance directives.
Posted on: Thu, 12 Sep 2013 21:11:10 +0000
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