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Research Article

Managing Acute Respiratory Failure During Exacerbation of Chronic Obstructive Pulmonary Disease

Greg L Schumaker and Scott K Epstein
Respiratory Care July 2004, 49 (7) 766-782;
Greg L Schumaker
Pulmonary, Critical Care, and Sleep Division, Tufts — New England Medical Center, Boston, Massachusetts
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Scott K Epstein
Department of Medicine, Caritas-St Elizabeth's Medical Center, and Tufts University School of Medicine, Boston, Massachusetts
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  • For correspondence: [email protected]
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Abstract

Exacerbations of chronic obstructive pulmonary disease (COPD) are a major health problem, causing more than half a million hospital admissions per year in the United States. Although overall mortality is low, it is substantially higher with severe exacerbations that require intensive care and mechanical ventilation. The majority of COPD exacerbations result from infection, with typical bacterial organisms most commonly identified. Numerous randomized controlled trials and meta-analyses have documented the benefits of antibiotics, low-flow oxygen, and systemic corticosteroids, and the therapeutic equivalency of the major classes of bronchodilators (short-acting β-agonist and anticholinergics). Randomized controlled trials also demonstrate that noninvasive ventilation can decrease the incidence of intubation, shorten stay, reduce infectious complications, and improve survival. Although patients who require intubation have the worst prognosis, the vast majority of them can be successfully liberated from mechanical ventilation. For invasively ventilated patients the clinical emphasis should be on improving patient-ventilator interaction and avoiding dynamic hyperinflation (intrinsic positive end-expiratory pressure).

  • chronic obstructive pulmonary disease
  • COPD
  • respiratory failure
  • bronchodilator
  • corticosteroid
  • oxygen therapy
  • mechanical ventilation
  • evidence-based medicine

Footnotes

  • Correspondence: Scott K Epstein MD, Department of Medicine, Caritas-St Elizabeth's Medical Center, and Tufts University School of Medicine, 736 Cambridge Street, Boston MA 02135;, E-mail: scott.epstein{at}tufts.edu.
  • Copyright © 2004 by Daedalus Enterprises Inc.
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Respiratory Care: 49 (7)
Respiratory Care
Vol. 49, Issue 7
1 Jul 2004
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Managing Acute Respiratory Failure During Exacerbation of Chronic Obstructive Pulmonary Disease
Greg L Schumaker, Scott K Epstein
Respiratory Care Jul 2004, 49 (7) 766-782;

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Managing Acute Respiratory Failure During Exacerbation of Chronic Obstructive Pulmonary Disease
Greg L Schumaker, Scott K Epstein
Respiratory Care Jul 2004, 49 (7) 766-782;
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Keywords

  • chronic obstructive pulmonary disease
  • COPD
  • respiratory failure
  • bronchodilator
  • corticosteroid
  • oxygen therapy
  • mechanical ventilation
  • evidence-based medicine

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