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Semin Respir Crit Care Med 2020; 41(06): 830-841
DOI: 10.1055/s-0040-1708837
Review Article

Chronic Obstructive Pulmonary Disease in the Intensive Care Unit: Antibiotic Treatment of Severe Chronic Obstructive Pulmonary Disease Exacerbations

Nita Gupta
1   Department of Emergency Medicine, Swedish Hospital, Chicago, Illinois
,
Ryan Haley
2   Department of Medicine, University at Buffalo, Buffalo, New York
,
Ashish Gupta
,
Sanjay Sethi
2   Department of Medicine, University at Buffalo, Buffalo, New York
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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.

Keywords

severe acute exacerbations of COPD - intensive care unit - antibiotics - microbiology - Pseudomonas aeruginosa


Publication History

Article published online:
11 August 2020

© 2020. Thieme. All rights reserved.

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