Chronic obstructive pulmonary disease (COPD): Severe respiratory

2021-08-02 11:48 PM

An exacerbation of chronic obstructive pulmonary disease (COPD) is a rapidly worsening, stable disease that no longer responds to usual daily treatment.

Chronic obstructive pulmonary disease (COPD)

Outline 

Chronic obstructive pulmonary disease (COPD) is a restrictive disease of lungs (obstructive lung disease). 

A variety of clinical factors are thought to influence the natural history and prognosis of patients with chronic obstructive pulmonary disease (COPD).

Most exacerbations of chronic obstructive pulmonary disease (COPD) are caused by respiratory infections. Empiric antibiotic therapy is indicated for patients who are likely to have a bacterial infection causing the exacerbation and for those who are most severely ill.

The Global Guidelines for Chronic Obstructive Pulmonary Disease (COPD) define an increase in COPD as an acute increase in symptoms that exceeds daily variability, often requiring a change in medications, including glucocorticoids. systemic, antibiotics, or supplemental oxygen.

An exacerbation of chronic obstructive pulmonary disease (COPD) is a rapidly worsening, stable disease that no longer responds to usual daily treatment.

Chronic obstructive pulmonary disease symptoms

Clinical symptoms

Has been diagnosed with chronic obstructive pulmonary disease.

Symptoms appear:

+ Difficulty breathing, wheezing.

+ Auscultation of the lungs has many snoring, hissing rales; There may be crackles or crackles (respiratory infections and sputum stagnation).

+ More phlegm, cloudy sputum.

+ There may be cyanosis, sweating.

+ Mental disorders, if there is severe difficulty breathing, consciousness may be disturbed, even coma.

Subclinical symptoms

PaO 2 decreased significantly, SpO 2 decreased, PaCO 2 increased, pH decreased.

Chest X-ray: picture of chronic obstructive pulmonary disease, may show opacity of new lung damage (pneumonia).

Causes

Respiratory infections: fever, leukocytosis, sputum profuse and cloudy, lungs have a lot of moist rales, chest X-ray shows lung lesions.

Improper treatment or use of drugs, abuse of sleeping pills, sedation.

Other causes: pulmonary embolism, heart failure.

Metabolic disorders: hyperglycemia, decreased potassium.

Other infections (abdomen, brain).

Differential diagnosis

Pulmonary tuberculosis.

Pneumothorax in patients with chronic obstructive pulmonary disease.

Asthma.

Assessment of severity of exacerbation

Table of Assess severity of chronic obstructive pulmonary disease

Assess severity of chronic obstructive pulmonary disease
Only 2 or more severity criteria at one level are sufficient.

Treatment of chronic obstructive pulmonary disease

Acute exacerbation with severe respiratory failure

Breathe oxygen through oxygen goggles, keep Sp02: 90% - 92%.

Use a topical bronchodilator:

+ Parasympathomimetic drugs, nebulized through a mask of 5mg (salbutamol, terbutalin), repeated depending on the patient's condition, can be many times.

+ Parasympathomimetic: ipratropium (0.5mg) nebulized through the mask, repeat if necessary.

Combined intravenous infusion of sympathomimetic agents (salbutamol, terbutaline).

+ Initial rate 0.1μg/kg/min, adjust the dose according to patient response (increase infusion rate every 5-10 minutes until response).

+ Aminophylline 0.24g can be mixed with 100ml of 5% glucose solution, infused over 30-60 minutes, then maintained at a dose of 0.5mg/kg/hour.

Methylprednisolone 2mg/kg/24 hours IV in 2 divided doses.

Antibiotic:

+ 3rd generation cephalosporins (cefotaxime or ceftazidime 3g/day).

+ Combined with aminoglycoside or fluoroquinolone group.

+ If the nosocomial infection is suspected: use antibiotics according to the de-escalation regimen, use broad-spectrum antibiotics, and are effective on blue pus bacilli.

Non-invasive mechanical ventilation

If there are no contraindications.

Often choose BiPAP method:

+ Start with: IPAP = 8 - 10cm of water.

EPAP = 4-5cm of water.

FiO 2 adjusted to have Sp02 > 92%.

+ Adjust parameters: increase IPAP by 2cm of water each time.

+ Objectives: patient is comfortable, respiratory rate < 30 breaths/minute, SpO 2 > 92%, test without respiratory acidosis.

If noninvasive ventilation is ineffective or contraindicated: intubation and artificial ventilation through the endotracheal tube.

Intrusive mechanical ventilation

Modalities: assisted ventilation/volume control should be indicated.

+ Vt = 5-8ml/kg. + l/E = 1/3.

+ Trigger 3-4 liters/minute.

+ Fi02 is set at 100% at first, then adjusted according to blood oxygen.

+ PEEP = 5cm of water or set by 0.5 autoPEEP.

Parameters were adjusted to keep Pplat < 30cm of water, auto-PEEP not increased, SpO 2 > 92%, blood pH above 7.20. Maintain respiratory rate at about 20 breaths/minute with sedation.

In cases where the patient has severe dyspnea and is not on mechanical ventilation, switch to controlled ventilation (volume or pressure). However, the use of high doses of sedation or muscle relaxants can make weaning off mechanical ventilation difficult.

Assess the patient's condition daily to consider weaning off mechanical ventilation when the decompensated factors have been stabilized.

Squeeze the ball through the mask with 100% oxygen.

Endotracheal intubation, artificial ventilation.

Aspiration of sputum through an endotracheal tube.

Use intravenous bronchodilators.

Intravenous corticosteroid injection.

Administer intravenous antibiotics.

Related articles:

Chronic obstructive pulmonary disease (COPD)

Obstructive lung disease

Restrictive disease of lungs

Lecture on treatment of chronic obstructive pulmonary disease (COPD)