Chapter

Management of acute exacerbations including non-invasive and invasive ventilation

Clare L.K. Ross and William L.G. Oldfield

Edited by Onn Min Kon

in Chronic Obstructive Pulmonary Disease (COPD)

Published on behalf of Oxford University Press

ISBN: 9780199549146
Published online May 2011 | e-ISBN: 9780199607273 | DOI: http://dx.doi.org/10.1093/med/9780199549146.003.0007

Series: Oxford Respiratory Medicine Library

Management of acute exacerbations including non-invasive and invasive ventilation

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• An exacerbation of chronic obstructive pulmonary disease (COPD) is a sustained worsening of a patient’s symptoms from their usual stable state, which is beyond normal day-to-day variations, and is acute in onset. • Oxygen supplementation should be given in a controlled manner to maintain adequate levels of oxygenation. If hypercapnia and a respiratory acidosis develop or worsen, ventilatory support should be considered. • Medical management consists of bronchodilators, corticosteroids, and, in some situations, antibiotics. Adequate hydration and nutrition should also be provided. • Non-invasive ventilation (NIV) should be instituted, in addition to medical management, in patients with acute hypercapnic respiratory failure with an associated respiratory acidosis (pH < 7.35). • Patients can often be managed in a Hospital-at-Home (HaH) scheme after careful consideration of symptom severity, co-morbidities, baseline function, and home situation.

Chapter.  3358 words. 

Subjects: Respiratory Medicine and Pulmonology

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