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    AECOPD Guideline

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    Operations Manager - CMC
    This document provides guidelines for treating patients with confirmed chronic obstructive pulmonary disease (COPD) experiencing an acute exacerbation. It outlines assessing patients based on symptoms and examination findings. It recommends arranging investigations like arterial blood gases, chest X-rays, and cultures. Treatment involves controlled oxygen, nebulized bronchodilators, corticosteroids, antibiotics if indicated, IV fluids, and respiratory support if needed. It provides criteria for determining if non-invasive ventilation or intubation is required based on arterial blood gas values and pH levels.

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    AECOPD Guideline

    Uploaded by

    Operations Manager - CMC
    187 views1 page
    This document provides guidelines for treating patients with confirmed chronic obstructive pulmonary disease (COPD) experiencing an acute exacerbation. It outlines assessing patients based on symptoms and examination findings. It recommends arranging investigations like arterial blood gases, chest X-rays, and cultures. Treatment involves controlled oxygen, nebulized bronchodilators, corticosteroids, antibiotics if indicated, IV fluids, and respiratory support if needed. It provides criteria for determining if non-invasive ventilation or intubation is required based on arterial blood gas values and pH levels.

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    CMC AE of COPD

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    This document provides guidelines for treating patients with confirmed chronic obstructive pulmonary disease (COPD) experiencing an acute exacerbation. It outlines assessing patients based on symptoms and examination findings. It recommends arranging investigations like arterial blood gases, chest X-rays, and cultures. Treatment involves controlled oxygen, nebulized bronchodilators, corticosteroids, antibiotics if indicated, IV fluids, and respiratory support if needed. It provides criteria for determining if non-invasive ventilation or intubation is required based on arterial blood gas values and pH levels.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    187 views1 page

    AECOPD Guideline

    Uploaded by

    Operations Manager - CMC
    This document provides guidelines for treating patients with confirmed chronic obstructive pulmonary disease (COPD) experiencing an acute exacerbation. It outlines assessing patients based on symptoms and examination findings. It recommends arranging investigations like arterial blood gases, chest X-rays, and cultures. Treatment involves controlled oxygen, nebulized bronchodilators, corticosteroids, antibiotics if indicated, IV fluids, and respiratory support if needed. It provides criteria for determining if non-invasive ventilation or intubation is required based on arterial blood gas values and pH levels.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    To be used in patients with confirmed COPD who have an acute exacerbation

    Patient assessment
    Symptoms Examination
    Either of: - ABCDE
    - Increased SOB - Look in particular for peripheral oedema,
    - Increased wheeze cyanosis, drowsiness, and/or confusion as these
    - Increased cough and/or sputum may indicate a severe exacerbation
    production or purulence

    -
    Arrange Investigations - should not delay management
    - ABG - Ideally should be performed within 10 minutes of arrival to ER in a severely
    breathless patient. Should be repeated within 15-30 minutes if there is a change in FiO₂
    - CXR
    - Bloods including FBC and U+Es
    - ECG
    - Cultures - Sputum +/- Blood (if pyrexial)

    Management
    - Controlled oxygen. Give lowest FiO₂ needed to keep saturations 88-92%. Start with 28% and
    titrate as needed
    - Nebulised Salbutamol 5mg and Ipratropium 500mcg. In those at risk of hypercapnic
    respiratory failure use compressed air to drive nebuliser with supplemental O₂ given by nasal
    cannulae
    - Corticosteroids. Prednisolone 30mg PO / Hydrocortisone 100-200mg IV in severe exacerbation
    - Consider Antibiotics. These should be used if history of more purulent sputum, clinical signs of
    pneumonia or consolidation on CXR
    - Consider IV Fluids, diuretics, aminophylline if indicated
    - Consider need for respiratory support (see below)

    NIV / Intubation? Respiratory failure


    Oxygen to maintain Saturations 88-92% Type I = PaO₂ < 60mmHg, PaCO₂ < 50mmHg
    Obtain ABG
    Ensure PaO₂ > 60mmHg Type II = PaO₂ < 60mmHg, PaCO₂ > 50mmHg
    Is PaCO₂ > 50mmHg

    No - No change Yes - pH < 7.35 (with PaO₂ > 60mmHg) despite maximal medical
    Continue as above treatment

    No - No change Yes - Consider NIV or Intubation


    Continue as above

    ABGs should be repeated every hour until the patient is stable or more frequently if there is
    deterioration in clinical condition and within 15-30minutes if there is a change in FiO₂

    Dr. Dayaram Lamsal, Dr. Thomas Barker (UK), Dr. Joanna Metcalf (UK) 2073. CMC ED
    Adapted from European Respiratory Journal and NICE Guideline CG101, June 2010

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