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. ¶ 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