Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline
Six questions about the exacerbation itself, answered where the evidence allowed and left open where it did not. Oral corticosteroids are suggested over intravenous in the patient who can swallow, and the course is short: five days, not the two weeks that convention had settled on. Antibiotics are suggested in the exacerbation that needs hospital admission. Non-invasive ventilation is recommended for the patient whose exacerbation brings acidotic hypercapnic respiratory failure, which is the one recommendation here that changes who survives. Home-based management and a pulmonary rehabilitation programme begun within three weeks of discharge are both suggested. The register's two trials behind these recommendations are below.
Esta norma cita 2 dos 35 ensaios marcantes do nosso registo de Pneumologia.
How long a steroid course1
- 2013REDUCEPneumo · DPOC · Duração dos esteroidesEm 314 doentes com exacerbação de DPOC, 5 dias de prednisona 40 mg foi não-inferior relativamente à re-exacerbação aos 180 dias em comparação com tratamento de 14 dias.
Non-invasive ventilation in respiratory failure1
- 1995Brochard NIVPneumo · DPOC · VNIEm 85 doentes com insuficiência respiratória hipercápnica aguda por DPOC, a VNI por máscara facial reduziu a intubação e a mortalidade hospitalar em comparação com terapia padrão.