COPD in the Intensive Care Unit

Antoni Torres, MD, PhD, FERS, FCCP

Miguel Ferrer, MD, PhD, FERS

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent chronic diseases, resulting in a major burden for health services worldwide.

Patients with COPD may experience an acute worsening of respiratory symptoms, sometimes accompanied by cough and sputum production and increased sputum purulence that results in additional therapy, defined as a COPD exacerbation (AECOPD). In addition to economic consequences, including lost work productivity and increased utilization of health care resources, hospitalization for AECOPD is accompanied by a rapid decline in health status with a high risk of mortality or other negative outcomes such as need for endotracheal intubation or intensive care unit (ICU) admission.

Severe acute respiratory failure (ARF) due to AECOPD is a frequent cause for patient admission to the ICU. Assisted mechanical ventilation is currently the life-support technique that is most frequently used in critically ill COPD patients who are admitted to the ICU. Noninvasive respiratory support techniques, particularly noninvasive ventilation, are the first-line strategy and currently the standard of care. In recent years, high-flow nasal therapy has been proposed as an alternative therapy on this setting. In the most severe conditions, however, invasive mechanical ventilation is required in these patients,

This issue for Seminars in Respiratory and Critical Care Medicine is intended as an update on various aspects and novel developments that have occurred in recent years regarding the management of COPD patients in the ICU. In addition to the ventilatory support in AECOPD, topics that have been included are the role of pneumonia as the cause of ICU admission, the role of comorbidities during the ICU stay, and after discharge, the antibiotic and nonantibiotic pharmacological treatment in these patients, the role of Aspergillus spp. identification, and different aspects of physiotherapy and rehabilitation in the ICU. We have also included advanced therapies in COPD patients such as lung volume reduction techniques in pulmonary emphysema and the management of lung transplantation in the ICU.

As guest editors, we invited international experts to write up-to-date reviews based on their expertise and long-time experiences within this field. We would like to take this opportunity to warmly thank all the contributors for their enthusiasm and hard work. We are also indebted to Prof. Joseph Lynch, editor-in-chief of Seminars in Respiratory and Critical Care Medicine, as well as all those at the editorial office for their excellent technical help in producing this issue.

Publication History

Article published online:
28 July 2020