Search In this Thesis
   Search In this Thesis  
العنوان
Recent Trends in Management of A Patient
with chronic Obstructive Pulmonary
Disease In Intensive Care Unit /
المؤلف
Mohamed,Amr Ramadan.
هيئة الاعداد
باحث / Amr Ramadan Mohamed
مشرف / Mohamed Anwar El Shafei
مشرف / Ashraf El Sayed El Agamy
مشرف / Eman Abobakr El Siddik Ahmed Bayoumi
تاريخ النشر
2017
عدد الصفحات
150p.:
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
العناية المركزة والطب العناية المركزة
تاريخ الإجازة
1/1/2017
مكان الإجازة
جامعة عين شمس - كلية الطب - الرعاية المركزة
الفهرس
Only 14 pages are availabe for public view

from 150

from 150

Abstract

Chronic Obstructive Pulmonary Disease (COPD), a
common preventable and treatable disease, is characterized
by persistent airflow limitation that is usually progressive
and associated with an enhanced chronic inflammatory
response in the airways and the lung to noxious particles or
gases. Exacerbations and comorbidities contribute to the
overall severity in individual patients.
Inhaled cigarette smoke and other noxious particles
cause lung inflammation which may induce parenchymal
tissue destruction (emphysema and disrupt normal repair and
defense mechanisms.
A clinical diagnosis of COPD should be considered in
any patient who has dyspnea, chronic cough or sputum
production, and a history of exposure to risk factors for the
disease.
Spirometry is required to make the diagnosis in this
clinical context; the presence of a post-bronchodilator
FEV1/FVC < 0.70 confirms the presence of persistent
airflow limitation and thus of COPD.
The goals of COPD assessment are to determine the
severity of the disease, including the severity of airflow
limitation, the impact on the patient‘s health status.
Comorbidities occur frequently in COPD patients,
including cardiovascular disease, skeletal muscle
dysfunction, metabolic syndrome, osteoporosis, depression,
and lung cancer.Each pharmacological treatment regimen needs to be
patient-specific, guided by severity of symptoms, risk of
exacerbations, drug availability, and the patient‘s response.
For both beta2-agonists and anticholinergics, longacting
formulations are preferred over short-acting
formulations. Based on efficacy and side effects, inhaled
bronchodilators are preferred over oral bronchodilators.
Long-term treatment with inhaled corticosteroids
added to long-acting bronchodilators is recommended for
patients at high risk of exacerbations.
The phosphodiesterase-4 inhibitor roflumilast may be
useful to reduce exacerbations for patients with FEV1 <
50% predicted, chronic bronchitis, and frequent
exacerbations.
An exacerbation of COPD is an acute event
characterized by a worsening of the patient‘s respiratory
symptoms that is beyond normal day-to-day variations and
leads to a change in medication.
The diagnosis of an exacerbation relies exclusively on
the clinical presentation of the patient complaining of an
acute change of symptoms (baseline dyspnea, cough, and/or
sputum production) that is beyond normal day-to-day
variation.
Short-acting inhaled beta2-agonists with or without
short-acting anticholinergics are usually the preferred
bronchodilators for treatment of an exacerbation Systemic corticosteroids and antibiotics can shorten
recovery time, improve lung function (FEV1) and arterial
hypoxemia (PaO2), and reduce the risk of early relapse,
treatment failure, and length of hospital stay.
Oxygen therapy is a key component of hospital
treatment of an exacerbation. Venturi masks (high flow
devices) offer more accurate and controlled delivery of
oxygen than do nasal prongs but are less likely to be
tolerated by the patient. Ventilator support in an
exacerbation can be provided by either non-invasive (nasal
or facial mask) or invasive ventilation (oro-tracheal tube or
trachestomy).