Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts; and Northeastern University, Boston, Massachusetts.
Respir Care. 2023 Jun;68(6):821-837. doi: 10.4187/respcare.11069.
A COPD exacerbation is characterized by an increase in symptoms such as dyspnea, cough, and sputum production that worsens over a period of 2 weeks. Exacerbations are common. Respiratory therapists and physicians in an acute care setting often treat these patients. Targeted O therapy improves outcomes and should be titrated to an S of 88-92%. Arterial blood gases remain the standard approach to assessing gas exchange in patients with COPD exacerbation. The limitations of arterial blood gas surrogates (pulse oximetry, capnography, transcutaneous monitoring, peripheral venous blood gases) should be appreciated so that they can be used wisely. Inhaled short-acting bronchodilators can be provided by nebulizer (jet or mesh), pressurized metered-dose inhaler (pMDI), pMDI with spacer or valved holding chamber, soft mist inhaler, or dry powder inhaler. The available evidence for the use of heliox for COPD exacerbation is weak. Noninvasive ventilation (NIV) is standard therapy for patients who present with COPD exacerbation and is supported by clinical practice guidelines. Robust high-level evidence with patient important outcomes is lacking for the use of high-flow nasal cannula in patients with COPD exacerbation. Management of auto-PEEP is the priority in mechanically ventilated patients with COPD. This is achieved by reducing airway resistance and decreasing minute ventilation. Trigger asynchrony and cycle asynchrony are addressed to improve patient-ventilator interaction. Patients with COPD should be extubated to NIV. Additional high-level evidence is needed before widespread use of extracorporeal CO removal. Care coordination can improve the effectiveness of care for patients with COPD exacerbation. Evidence-based practices improve outcomes in patients with COPD exacerbation.
COPD 加重的特征是呼吸困难、咳嗽和咳痰等症状加重，且在 2 周内逐渐恶化。加重是常见的。急性护理环境中的呼吸治疗师和医生通常会治疗这些患者。有针对性的 O 治疗可改善结局，应滴定至 S 为 88-92%。动脉血气仍然是评估 COPD 加重患者气体交换的标准方法。应了解动脉血气替代物（脉搏血氧饱和度、二氧化碳描记法、经皮监测、外周静脉血气）的局限性，以便明智地使用。吸入短效支气管扩张剂可通过雾化器（射流或网孔）、压力定量吸入器（pMDI）、带或不带活瓣保持室的 pMDI、软雾吸入器或干粉吸入器给药。氦氧混合气用于 COPD 加重的证据较弱。对于出现 COPD 加重的患者，非侵入性通气（NIV）是标准治疗方法，并得到临床实践指南的支持。对于 COPD 加重患者使用高流量鼻导管，缺乏具有患者重要结局的强有力的高级别证据。机械通气 COPD 患者的管理重点是自动 PEEP 的管理。这可以通过降低气道阻力和减少分钟通气量来实现。触发不同步和周期不同步通过改善患者-呼吸机交互来解决。COPD 患者应插管至 NIV。在广泛应用体外 CO 去除之前，需要更多的高级别证据。护理协调可以提高 COPD 加重患者护理的有效性。循证实践可改善 COPD 加重患者的结局。
