Acute COPD exacerbation

Diagnosis: The acute COPD exacerbation with the decompensated respiratory acidosis — the worsening breathlessness and the purulent sputum (the Anthonisen criteria met — the antibiotics indicated), the hypoxaemia (the 84 per cent), and the arterial blood gas (the pH 7.28, the carbon dioxide raised) — the decompensated acute hypercapnic respiratory acidosis that triggers the non-invasive ventilation.^[2]

Management:

1. The ABCDE.
2. The controlled oxygen — the target saturation 88 to 92 per cent (the AVOIDANCE of the high-flow oxygen and the carbon dioxide narcosis). The venturi mask, the careful titration.^[2]
3. The nebulised bronchodilators — the salbutamol and the ipratropium, driven by the air or the controlled oxygen.
4. The systemic corticosteroids — the prednisolone 40 milligrams orally daily for 5 days (or the hydrocortisone intravenously).
5. The antibiotics — the Anthonisen criteria met (the increased dyspnoea and the purulent sputum) — the amoxicillin-clavulanate, or the doxycycline, by the severity and the local.
6. The non-invasive ventilation (the BiPAP) — the first-line for the decompensated acidosis (the pH 7.28). The continuous, the monitoring of the arterial blood gas for the improvement (the rising pH and the falling carbon dioxide).^[3]
7. The investigation of the trigger — the chest radiograph (the pneumonia, the pneumothorax), the ECG (the arrhythmia), and the pulmonary-embolism workup if the suspicion.
8. The AVOIDANCE of the sedatives.

The disposition: The high-dependency or the intensive care, the continuous monitoring, the gradual wean of the NIV as the acidosis resolves.^[3]