COPD

COPD

  • Trial of NIPPV: BPAP (need insp and exp pressures to ventilate, think of BPAP as external diaphragm)
    • Check ABG at start and within 45 min, if PCO2 is getting worse, intubate
  • Indications for intubation: insufficient mental status for BPAP, copious secretions, respiratory acidosis (pH<7.2 – 7.25) worsening on NIPPV, hemodynamic instability
    • Allow long enough expiratory phase
    • Make sure no auto-PEEP
    • Goal is pt’s baseline pCO2 not a normal pCO2
    • Consider extubating to BPAP
  • Standard treatment:
    • O2 > 88-90%
    • Prednisone 40 daily x5 days (methylprednisolone is only required for IV administration if pt cannot take po, IV STEROIDS ARE NOT “STRONGER”)
    • Albuterol (SABA) + ipratroprium (SAMA) or tiotroprium (LAMA)
    • Budesonide = LABA
    • Abx: 5-10 days, choice depends on patient (increased sputum volume, increased sputum purulence)
      • High-risk: Levofloxacin or Zosyn
      • Low-risk: Augmentin or Doxycycline (beware azithromycin and arrhythmias)