COPD exacerbation and NIV Flashcards
1
Q
What is an excerbation of COPD?
A
- Acute episodes
- Sustained worsening of COPD symptoms
- eg. dyspnoea; cough; sputum
- Beyond normal day-to-day variations
2
Q
Name two triggers for exacerbations of COPD
A
- Respiratory tract infections
- Most commonly rhinovirus
- Smoking
- Environmental pollutants
3
Q
Give three symptoms of an exacerbation of COPD
A
- Worsening:
- Dyspnoea
- Cough
- Sputum production; change in colour
- Other:
- Increased wheeze; chest tightness
- URT symptoms: eg. cold; sore throat
- Reduced exercise tolerance
- Ankle swelling
- Fatigue
- Delirium
4
Q
Provide two features suggestive of a severe exacerbation of COPD
A
- Marked dyspnoea and tachypnoea
- Pursed-lip breathing; use of accessory muscles at rest
- New-onset cyanosis; peripheral oedema
- Delirium; drowsiness
- Marked reduced in ADLs
5
Q
Request four investigations for an acute exacerbation of COPD
A
All acute exacerbations presenting to hospital:
- CXR
- ABG
- ECG: exclude comorbidities
- FBC; U+E; CRP
- Theophylline level: if on theophylline therapy
- Sputum microscopy/culture: if purulent
- Blood cultures: if pyrexic
6
Q
Outline the management of exacerbations of COPD
A
- Salbutamol 5mg/4h + ipratropium 500mcg/6h
- O2 as needed: high flow, then titrate to target levels
- 30mg PO prednisolone or 200mg IV hydrocortisone for 5/7
- Consider PPIs and bisphosphonates
- Chest physiotherapy: aid sputum expectoration
- Consider
- IV aminophylline
- Frequent monitoring
- NIV
- ITU for invasive ventilation
- IV aminophylline
Consider need for antimicrobials eg. amoxicillin
7
Q
What are the indications for acute non-invasive ventilation?
A
- COPD: either
- pH <7.35; pCO2 >6.5; RR >23
- Persisting after bronchodilator and controlled O2 therapy
- Neuromuscular disease: either
- Respiratory illness w/ RR >20 if usual VC <1L
- pH <7.35 and pCO2 >6.5
- Obesity: either
- pH <7.35; pCO2 >6.5; RR >23
- Daytime pCO2 >6.0 and somnolent
9
Q
Give three contraindications for non-invasive ventilation
A
- Severe facial deformity
- Facial burns
- Fixed upper airway obstruction
- pH <7.15
- GCS <8
- Confusion; agitation
- Cognitive impairment
10
Q
Outline the discharge planning following exacerbation of COPD
A
- Spirometry prior to discharge
- Re-establish optimal maintenance bronchodilators
- Satisfactory SaO2/ABG if episode of respiratory failure
- Medication review and education
- Consider follow-up and home care