【COPD英文精品课件】慢阻肺急性发作Acute Exacerbation of Chronic Obstructive Pulmonary Disease.ppt

Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Prof. Ashraf M. Hatem, MD, FCCP Definition of Acute exacerbation: The definition of COPD exacerbation is an acute change in a patient’s baseline dyspnoea, cough and/or sputum beyond day-to-day variability sufficient to warrant a change in therapy. Causes of exacerbation can be both infectious and non-infectious e.g. air pollution. Most commonly encountered organisms: -Streptococcus pneumoniae -Hemophilus influenzae -Moraxella catarrhalis The cause in one third of exacerbations remains unidentified Classification of Severity of Acute Exacerbation of COPD The Operational Classification of Severity is as follows: Level I: ambulatory (outpatient), Level II: requiring hospitalisation, and Level III: acute respiratory failure. The Operational Classification of Severity of COPD exacerbation Indications for hospitalisation of patients with a COPD exacerbation Presence of high-risk co-morbid conditions, including pneumonia, cardiac arrhythmia, congestive heart failure, diabetes mellitus, renal or liver failure Inadequate response of symptoms to outpatient management Marked increase in dyspnoea Inability to eat or sleep due to symptoms Worsening hypoxaemia Worsening hypercapnia Changes in mental status Inability of the patient to care for her/himself Uncertain diagnosis Inadequate home care Level I: outpatient treatment Level II: treatment for hospitalised patient Level III: treatment in patients requiring special or intensive care unit In-patient Oxygen Therapy The goal is to prevent tissue hypoxia by maintaining arterial oxygen saturation (Sa,O2) at 90%. Main delivery devices include nasal cannula and venturi mask. Alternative delivery devices include nonrebreather mask, reservoir cannula, nasal cannula or transtracheal catheter. Arterial blood gases should be monitored for arterial oxygen tension (Pa,O2), arterial carbon dioxide tension (Pa,CO2) and pH. Arterial oxygen saturation as measured by pulse