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Algorithm for triage of patients presenting with COPD exacerbation*

Algorithm for triage of patients presenting with COPD exacerbation*

COPD: chronic obstructive pulmonary disease; ICU: intensive care unit; SpO2: pulse oxygen saturation; NIV: noninvasive positive pressure ventilation via nasal mask, face mask, or nasal plugs; ABG: arterial blood gas; PaCO2: arterial tension of carbon dioxide; FEV1: forced expiratory volume in one second; PaO2: arterial oxygen tension.

* This algorithm can be used to support decisions regarding hospitalization and ventilatory support, but clinical judgment should be employed in all cases. Prior goals of care and advance care planning discussions should be reviewed to ensure that decisions, particularly about invasive ventilation, are consistent with the patient's values and preferences. Short-acting bronchodilators should be given during triage assessment; symptomatic improvement with bronchodilator administration may impact triage decisions.

¶ Contraindications to NIV:
  • Inability to protect the airway or clear secretions
  • Severely impaired consciousness
  • Nonrespiratory organ failure that is acutely life-threatening
  • High aspiration risk
  • Inability to cooperate
  • Facial surgery, trauma, or deformity
  • Recent esophageal anastomosis

Δ Indications for ICU admission vary among institutions and generally include (but are not limited to) the following:

  • Hemodynamic instability requiring vasopressor support
  • Unstable cardiac events (eg, acute myocardial infarction, complex arrhythmias, cardiogenic shock)
  • Severe neurologic complications (eg, major acute intracranial hemorrhage or stroke, status epilepticus)
  • Persistent or worsening hypoxemia (eg, PaO2 <50 mmHg [6.62 kPa] despite supplemental oxygen)
  • Need for monitoring or nursing care that exceeds the capacity of non-ICU settings

◊ Severe airflow limitation, a history of frequent or severe exacerbations, and frailty are additional factors that may be associated with increased risk for severe exacerbation.

Graphic 114160 Version 3.0

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