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Management of acute exacerbations including non-invasive and invasive ventilation 

Management of acute exacerbations including non-invasive and invasive ventilation
Management of acute exacerbations including non-invasive and invasive ventilation

Clare L.K. Ross

, and William L.G. Oldfield

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date: 23 September 2020

An exacerbation of chronic obstructive pulmonary disease (COPD) is a sustained worsening of a patient’s symptoms from their usual stable state, which is beyond normal day-to-day variations, and is acute in onset.

Oxygen supplementation should be given in a controlled manner to maintain adequate levels of oxygenation. If hypercapnia and a respiratory acidosis develop or worsen, ventilatory support should be considered.

Medical management consists of bronchodilators, corticosteroids, and, in some situations, antibiotics. Adequate hydration and nutrition should also be provided.

Non-invasive ventilation (NIV) should be instituted, in addition to medical management, in patients with acute hypercapnic respiratory failure with an associated respiratory acidosis (pH < 7.35).

Patients can often be managed in a Hospital-at-Home (HaH) scheme after careful consideration of symptom severity, co-morbidities, baseline function, and home situation.

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