Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Patients with chronic obstructive pulmonary disease (COPD) who acutely decompensate may benefit from admission to the ICU. Patients with COPD admitted to an ICU for an acute exacerbation of COPD have a hospital mortality between 10% and 25% with a 1- year mortality of about 40%. However, the need for mechanical ventilation appears not to influence either short- or long-term outcome; therefore, the need for mechanical ventilation should not be used as a reason for not offering respiratory support. Noninvasive positive pressure ventilation (NPPV) is a viable alternative to endotracheal intubation in patients with a COPD exacerbation, and depending on the circumstances, this may be instituted on a general medical floor, a step-down unit, or in a medical ICU. NPPV should be considered in patients with severe COPD who have indicated their preference for the limitation of life-sustaining therapy.