Therapeutic strategy in acute or chronic airflow limitation

2016 ◽  
Author(s):  
Francesco Macagno ◽  
Massimo Antonelli
Keyword(s):  
Bacterial Infections ◽  
Blood Gases ◽  
Airflow Limitation ◽  
Inhalation Therapy ◽  
Chronic Obstructive ◽  
Therapeutic Success ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Established Role

The fragility of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) accounts for their frequent hospitalization and their high intensive care unit risk. Therapy for AECOPD is varied and the need for hospitalization must be always carefully evaluated, considering the risk factors related to the presence of multi-resistant pathogens or the need of invasive procedures. The prolonged use of oxygen therapy requires an accurate monitoring of blood gases and continuous oximetry. Inhalation therapy can be performed using nebulizers, predosed aerosols or powders for inhalation. Corticosteroids for oral and systemic use now play an established role in AECOPD, because bacterial infections account for 50% of exacerbations. Non-invasive ventilation (NIV) must be considered the first option in AECOPD patients and acute respiratory failure if there are no contraindications. The careful monitoring of the patient and the response to NIV are indispensable elements for therapeutic success.

scholarly journals Chronic non-invasive ventilation for chronic obstructive pulmonary disease

2021 ◽  
Vol 2021 (8) ◽  
Author(s):  
Tim Raveling ◽  
Judith Vonk ◽  
Fransien M Struik ◽  
Roger Goldstein ◽  
Huib AM Kerstjens ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation

scholarly journals Extracorporeal carbon dioxide removal for treatment of exacerbated chronic obstructive pulmonary disease (ORION): study protocol for a randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tommaso Tonetti ◽  
Lara Pisani ◽  
Irene Cavalli ◽  
Maria Laura Vega ◽  
Elisa Maietti ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Controlled Trial ◽  
Invasive Mechanical Ventilation ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Acute Exacerbations

Abstract Background Hypercapnic exacerbations are severe complications of chronic obstructive pulmonary disease (COPD), characterized by negative impact on prognosis, quality of life and healthcare costs. The present standard of care for acute exacerbations of COPD is non-invasive ventilation; when it fails, the use of invasive mechanical ventilation is inevitable, but is associated with extremely poor prognosis. Extracorporeal circuits designed to remove CO2 (ECCO2R) may enhance the efficacy of NIV to remove CO2 and avoid the worsening of respiratory acidosis, which inevitably leads to failure of non-invasive ventilation. Although the use of ECCO2R for acute exacerbations of COPD is steadily increasing, solid evidence on its efficacy and safety is scarce, thus the need for a randomized controlled trial. Methods multicenter randomized controlled unblinded clinical trial including 284 (142 per arm) patients with acute hypercapnic respiratory failure caused by exacerbation of COPD, requiring respiratory support with NIV. The primary outcome is event free survival at 28 days, a composite outcome defined by survival in absence of prolonged mechanical ventilation, severe hypoxemia, septic shock and second episode of COPD exacerbation. Secondary outcomes are incidence of endotracheal intubation and tracheostomy, intensive care and hospital length-of-stay and 90-day mortality. Discussion Acute exacerbations of COPD represent a significant burden in terms of prognosis, quality of life and healthcare costs. Lack definite evidence despite increasing use of ECCO2R justifies a randomized trial to evaluate whether patients with acute hypercapnic acidosis not responsive to NIV should undergo invasive mechanical ventilation (with all serious related risks) or be treated with ECCO2R to avoid invasive ventilation but be exposed to possible adverse events of ECCO2R. Owing to its pragmatic nature, sample size and composite primary outcome, this trial aims at providing valuable answers to relevant questions for clinical treatment of acute exacerbations of COPD. Trial registration ClinicalTrials.gov, NCT04582799. Registered 12 October 2020, .

scholarly journals A Case report on non-invasive ventilation in the management of acute COPD exacerbation (AECOPD)

KYAMC Journal ◽  
2013 ◽  
Vol 2 (1) ◽  
pp. 152-155
Author(s):  
Mohammed Yousuf ◽  
Khan Assaduzzaman ◽  
Mohammad Saiful Islam ◽  
SM Niaz Mowla
Keyword(s):  
Case Report ◽  
Vital Signs ◽  
Length Of Hospital Stay ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Risk Of Death ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Stay Time ◽  
Patient Stay

Recent years have seen the emergence of noninvasive ventilation (NIV) as an important tool for management of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Several well-conducted studies in the recent years have established its role in the initial, as well as later management of these patients. The aim of this case report is to encourage ICU physician to use NIV on selected AECOPD patients, therefore to reduce the need for endotracheal intubation, the length of hospital stay, and the risk of death. In this case report, we selected a case of AECOPD whose symptoms were getting worse in spite of adequate conventional treatment. He was given NIV for 20 hours following a standard protocol. Final result showed significant improvement in patient's symptoms, vital signs and ABG parameters ultimately patient stay time in ICU was reduced and patient was also benefited financially. From this first ever-successful application of NIV in our ICU we learned that we can use it successfully in next cases.DOI: http://dx.doi.org/10.3329/kyamcj.v2i1.13522 KYAMC Journal Vol.2(1) 2011 pp.152-155

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