Care of the Surgical ICU Patient with Chronic Obstructive Pulmonary Disease and Pulmonary Hypertension
Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease characterized by airflow limitation that is frequently progressive and associated with respiratory impairment. As the fourth leading cause of death in the United States and Europe, COPD results in a substantial and ever increasing economic and social burden . Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are frequently encountered in the intensive care unit (ICU). Although there is no standardized definition, AECOPD are characterized by a significant change in patient symptoms from baseline accompanied by overall increased airway resistance . These exacerbations carry a significant risk to patients, with 10 % in-hospital mortality and 1-year and 2-year all-cause mortality rates of 43 % and 49 %, respectively, in patients with hypercapnic exacerbations . Other studies note in-hospital mortality rates as high as 30 % with worse outcomes associated with older age, severity of respiratory and non-respiratory organ dysfunction, and hospital length of stay . Given that patients transferred to the ICU with AECOPD are at high risk for complications and adverse outcomes, early diagnosis and management are critical to improve patient outcomes and survival in this population.
KeywordsCOPD exacerbation Bronchodilators Auto-PEEP Right ventricular failure
- 3.Connors Jr AF, Dawson NV, Thomas C, et al. Outcomes following acute exacerbations of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am J Respir Crit Care Med. 1996;154:959–67.CrossRefGoogle Scholar
- 8.Global strategy for the diagnosis, management and prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2015. Available from: http://www.goldcopd.org/.
- 14.Sims M. Acute respiratory failure due to chronic obstructive pulmonary disease. In: Lanken P, Manaker S, Kohl BA, Hanson CW, editors. The intensive care unit manual. 2nd ed. Philadelphia: Elsevier Saunders; 2014. p. 715–22.Google Scholar
- 33.Jentzer JC, Mathier MA. Pulmonary hypertension in the intensive care unit. J Intensiv Care Med. 2015;1–17.Google Scholar
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