COPD Exacerbations: Significance, Assessment, and Current Management
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Presentation by Dr David Pierson, faculty of Pulmonary Medicine Update Course, Egypt. Knowledge resources at Scribe : www.scribeofegypt.com
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COPD Exacerbations: Significance, Assessment, and Current Management
- 1. David J Pierson MD Professor of Medicine University of Washington Seattle, WA, USA December, 2008 COPD Exacerbations: Significance, Assessment, and Current Management
- 7. According to Pre-Admission Quality of Life According to Patient Age Survival after ICU Admission for COPD Exacerbation* *Rivera-Fernandez R et al, Crit Care Med 2006;34(Sep):(e-pub)
- 8. Managing COPD Exacerbations: Performance of 360 US Hospitals vs ACP-ACCP Guidelines* *Lindenaur PK et al, Ann Intern Med 2006;144(12):894-903 ( ~ 70,000 Patients; 2001)
- 12. *Damarla M et al, Respir Care 2006 (Oct);51(10):1120-4. Use of Appropriate Diagnostic Confirmation in COPD vs CHF (in previous 8 years)*
- 24. Sudden Development vs Sudden Discovery Tachypnea Characteristic EMG Changes Paradoxical Respiration Respiratory Alternans CO 2 Retention Bradypnea Respiratory Arrest
- 27. *McCrory DC et al, Cochrane Reviews 2003(1):CD003900 Ipratropium vs Beta-Agonist in COPD Exacerbations : Meta-Analysis of RCTs*
- 28. *McCrory DC et al, Cochrane Reviews 2003(1):CD003900 Beta-Agonist +/- Ipratropium in COPD Exacerbations : Meta-Analysis of RCTs*
- 29. *McCrory DC et al, Cochrane Reviews 2003(1):CD003900 Beta-Agonist +/- Ipratropium in COPD Exacerbations : Meta-Analysis of RCTs*
- 30. Beta-Agonist Administration with MDI+Spacer vs Nebulizer in Adults with Acute Asthma: Improvement in FEV 1 * *Cates CJ et al, Cochrane Reviews 2006(2):CD000052
- 31. Beta-Agonist Administration with MDI+Spacer vs Nebulizer in Adults with Acute Asthma: Hospital Admission* *Cates CJ et al, Cochrane Reviews 2006(2):CD000052
- 34. Corticosteroids In COPD Exacerbations
- 40. *Wood-Baker RR et al, Cochrane Reviews 2005(1):CD001288 Management of COPD Exacerbation: Effect of Steroids on Early FEV 1 *
- 41. *Wood-Baker RR et al, Cochrane Reviews 2005(1):CD001288 Management of COPD Exacerbation: Effect of Steroids on Treatment Failure*
- 42. Wood-Baker RR et al, Cochrane Reviews 2005(1):CD001288
- 43. Wood-Baker RR et al, Cochrane Reviews 2005(1):CD001288
- 45. Antibiotics In COPD Exacerbations
- 48. Efficacy of Antibiotics According to Exacerbation Severity* *Anthonisen NR et al, Ann Intern Med 1987;106:196-204
- 49. *Anthonisen NR et al, Ann Intern Med 1987;106:196-204 Treatment Failure with Deterioration According to Exacerbation Severity*
- 50. *Ram FSF et al, Cochrane Reviews 2006(2):CD004403 Antibiotics in COPD Exacerbations: Meta-Analysis of RCTs*
- 51. Antibiotics vs Placebo in Managing COPD Exacerbations: Mortality in Best-Designed RCTs* *Ram FSF et al, Cochrane Reviews 2006(2):CD004403
- 52. RCTs of Antibiotics in COPD Exacerbations: Hospitalized Patients vs Outpatients* *Ram FSF et al, Cochrane Reviews 2006(2):CD004403
- 53. *Ram FSF et al, Cochrane Reviews 2006(2):CD004403 Antibiotics vs Placebo in COPD Exacerbations: Short-Term Mortality*
- 54. *Ram FSF et al, Cochrane Reviews 2006(2):CD004403 Antibiotics vs Placebo in COPD Exacerbations: Treatment Failure*
- 61. Patients with Higher Initial PaO 2 Tended to Have More Severe Acidemia* (Assumption is that they received too much O 2 initially) *Plant PK et al, Thorax 2000;55:550-4 < 55 55-75 75-100 > 100 Initial PaO 2 (mm Hg)
- 67. *Moloney ED et al, Lancet 2001;357:526-8 45 55 65 75 mm Hg 30 15 0 15 30 Changes in PCO 2 with Oxygen Therapy When SpO 2 is kept at 90-91%* PCO 2 Change vs Initial PCO 2 PCO 2 Change vs Initial pH
- 71. How Should Oxygen Be Delivered in Managing COPD Exacerbations? Nasal Venturi Cannula Mask Known, constant No (but this Yes (but delivered O 2 may not be not really) concentration? important) Likely to stay Yes No on patient? No need to remove Less well tolerated; for talking, eating, Must come off for aerosol Rx, etc talking, eating, meds Overall effectiveness ++ +
- 74. *Brochard L et al, NEJM 1995;333(13):817-822 NPPV in COPD Exacerbations : Patient Characteristics & Changes in the 1 st Hour*
- 75. *Brochard L et al, NEJM 1995;333(13):817-822 NPPV in COPD Exacerbations : Need for Intubation and Other Outcomes*
- 76. *Brochard L et al, NEJM 1995;333(13):817-822 NPPV in COPD Exacerbations : Timing of Need for Intubation*
- 77. *Brochard L et al, NEJM 1995;333(13):817-822 NPPV in COPD Exacerbations : Initial Effect on PCO 2 and PO 2 *
- 78. *Brochard L et al, NEJM 1995;333(13):817-822 NPPV in COPD Exacerbations : Effect on Length of Hospital Stay*
- 80. *Ram FSF et al, Cochrane Reviews 2004(3):CD004104 NPPV in COPD Exacerbations : Effect on Treatment Failure*
- 81. *Ram FSF et al, Cochrane Reviews 2004(3):CD004104 NPPV in COPD Exacerbations : Effect on Mortality*
- 82. *Ram FSF et al, Cochrane Reviews 2004(3):CD004104 Effect of NPPV on Need for Intubation*
- 83. *Ram FSF et al, Cochrane Reviews 2004(3):CD004104 NPPV in COPD Exacerbations : Effect on Length of Hospital Stay*
- 92. *Confalonieri M et al, Eur Respir J 2005;25:348-55 Predicting NPPV Failure in COPD Exacerbations: Risk of Failure at Time of Presentation*
- 93. *Confalonieri M et al, Eur Respir J 2005;25:348-55 Predicting NPPV Failure in COPD Exacerbations: Risk of Failure after 2 Hours*
- 94. *Confalonieri M et al, Eur Respir J 2005;25:348-55 Predicting NPPV Failure in COPD Exacerbations*