Abstract
Chronic obstructive pulmonary disease (COPD) significantly reduces quality of life and is one of the main causes of chronic morbidity and mortality worldwide. Acute exacerbation of COPD (AECOPD) is a life-threatening condition that causes rapid deterioration of respiratory symptoms (worsening of dyspnea, cough and/or abundant sputum production) requiring urgent treatment. This review article examines the evidence underlying supplemental oxygen therapy and ventilator support during exacerbations of COPD. In the introduction, we discuss the epidemiology and pathophysiology of hypercapnic respiratory failure, and then we explain that the key to achieving appropriate levels of oxygenation is using controlled low-flow oxygen therapy. In patients with risk of hypercapnia a target oxygen saturation (SaO2) range of 88%-92% is now generally accepted unless hypercapnia is disproved by gas analysis of arterial blood. However, if the partial pressure of carbon dioxide in arterial blood (PaCO2) is normal, oxygen therapy may target the usual saturation range of 94%-98%. Many COPD patients may have a lower stable SaO2, such that chasing this target (94%-98%) is not usually necessary unless the patient is unwell. Further, we review current recommendations for ventilatory support in patients with AEHOBP. Noninvasive ventilation has assumed an important role in managing patients with acute respiratory failure. The use of invasive ventilation is the last remaining option, associated with a poor outcome.
Highlights
Hronična opstruktivna bolest pluća (HOBP) je globalni zdravstveni problem i očekuje sa da do 2020. bude treći uzrok smrtnosti u svetu .[1]
Ako je došlo do porasta vrednosti PaCO2 ali je pH>7.35 ili je nivo bikarbonata >28 mmol/L, bolesnik verovatno ima dugotrajnu hiperkapniju i kod njega je ciljna vrednost SaO2 u rasponu od 88-92%
Nije bila uspešna ili ukoliko postoji nemogućnost iskašljavanja obilnog sekreta
Summary
Trpković S.1, Pavlović A.1, Videnović N.1, Marinković O.2, Sekulić A.2 1 Medicinski fakultet Univerziteta u Prištini, Kosovskoj Mitrovici, Srbija 2 Kliničko bolnički centar „Bežanijska kosa“, Beograd, Srbija. Medicinski fakultet Univerziteta u Prištini, Kosovskoj Mitrovici, Srbija 2 Kliničko bolnički centar „Bežanijska kosa“, Beograd, Srbija. Ovaj pregledni članak ispituje dokaze koji obuhvataju primenu oksigenoterapije i ventilatorne podrške u toku egzarcerbacije HOBP. Kod bolesnika koji su u riziku od hiperkapnije, ciljna vrednost zasićenja hemoglobina kiseonikom (SaO2) je u rasponu od 88-92%, dok se hiperkapnija ne isključi gasnim analizama arterijske krvi. Ako je vrednost parcijalnog pritiska ugljen-dioksida u arterijskoj krvi (PaCO2) normalna, ciljne vrednosti SaO2 mogu biti u rasponu od 94-98%. Dalje smo istražili važeće preporuke za primenu ventilatorne podrške kod bolesnika sa AEHOBP. Neinvazivna ventilacija je preuzela važnu ulogu u lečenju bolesnika sa akutnom respiratornom insuficijencijom nastalom zbog AEHOBP. Medical faculty University of Pristina, Kosovska Mitrovica, Serbia 2 Clinical Hospital Center „Bezanijska kosa“, Belgrade, Serbia Trpković S.1, Pavlović A.1, Videnović N.1, Marinković O.2, Sekulić A.2 1 Medical faculty University of Pristina, Kosovska Mitrovica, Serbia 2 Clinical Hospital Center „Bezanijska kosa“, Belgrade, Serbia
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