Abstract

Patients who suffer from chronic obstructive pulmonary disease (COPD) often experience deterioration of baseline respiratory symptoms, acute exacerbations of COPD (AECOPD), that become more frequent with disease progression. Based on symptom severity, approximately 20% of these patients will require hospitalization. The most common indicators for intensive care unit (ICU) admission have been found to be worsening or impending respiratory failure and hemodynamic instability. Bacterial and viral bronchial infections are the causative triggers in the majority of COPD exacerbations in the ICU, with a comprehensive assessment revealing them in 72% of cases. The distribution of bacterial pathogens involved in AECOPD requiring ICU admission show an increased incidence of gram-negative respiratory isolates, including Pseudomonas and Enterobacteriaceae spp., when compared with outpatient exacerbations. Evaluation of these patients requires careful attention to comorbid conditions. An effort to rapidly obtain lower respiratory samples for microbiological samples prior to initiation of antibiotics should be made as adequate samples can guide subsequent modifications of antibiotic treatment if the clinical response to empiric treatment is poor. Empiric antibiotic treatment should be promptly initiated in all patients with a major consideration for the choice being the presence of risk factors for Pseudomonas infection. Evaluation of clinical response at 48 to 72 hours is crucial, and total duration of antibiotics of 5 to 7 days should be adequate.

Publication History

Publication Date:
11 August 2020 (online)

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

中文翻译：

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重症监护病房的慢性阻塞性肺病：严重慢性阻塞性肺病加重的抗生素治疗。

摘要

患有慢性阻塞性肺疾病 (COPD) 的患者通常会出现基线呼吸道症状的恶化，即 COPD 急性加重 (AECOPD)，随着疾病进展，这种情况变得更加频繁。根据症状的严重程度，这些患者中约有 20% 需要住院治疗。已发现重症监护病房 (ICU) 入院的最常见指标是呼吸衰竭恶化或即将发生以及血流动力学不稳定。细菌和病毒性支气管感染是 ICU 中大多数 COPD 急性加重的诱因，综合评估显示 72% 的病例有这些原因。需要入住 ICU 的 AECOPD 中涉及的细菌病原体的分布显示革兰氏阴性呼吸道分离株的发生率增加，包括假单胞菌和肠杆菌科细菌，与门诊急性加重相比。对这些患者的评估需要仔细注意合并症。在开始使用抗生素之前，应努力快速获取下呼吸道微生物样本，因为如果对经验性治疗的临床反应不佳，足够的样本可以指导后续抗生素治疗的调整。所有患者都应立即开始经验性抗生素治疗，主要考虑因素是存在假单胞菌感染的危险因素。在 48 至 72 小时内评估临床反应至关重要，5 至 7 天的抗生素总持续时间应该足够。

出版历史

出版日期：
2020 年 8 月 11 日（在线）

© 2020. 蒂姆。版权所有。

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA。