open access

Vol 14, No 2 (2020)
Case report
Published online: 2020-05-16
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Advanced COPD in a patient treated in the Intensive Care Unit

Urszula Kościuczuk1, Ewa Tałałaj2, Piotr Jakubów34, Adam Łukasiewicz5
·
Palliat Med Pract 2020;14(2):130-134.
Affiliations
  1. Uniwersytet Medyczny w Białymstoku, ul. Skłodowskiej 24A, 15-276 Białystok, Poland
  2. Studenckie Koło Naukowe przy Klinice Anestezjologii i Intensywnej Terapii, Uniwersytet Medyczny w Białymstoku, Sklodowskiej- Curie 24 A, 15-276 Bialystok, Poland
  3. konsultant województwa podlaskiego w dziedzinie medycyna paliatywna
  4. Non-Public Health Care Unit Edyty Jakubów “Vitamed”, Białystok, Poland
  5. Klinika Radiologii, Uniwersytet Medyczny w Białymstoku

open access

Vol 14, No 2 (2020)
Case report
Published online: 2020-05-16

Abstract

Chronic obstructive pulmonary disease (COPD) is the 3rd leading cause of death worldwide and 7th in
the classification of years of life lost or lived with disability. Indeed, COPD prevalence is still increasing.
Moreover, chronic respiratory failure in advanced COPD is one of the most common indications for palliative
care. The deterioration of general health, including respiratory failure, raises many doubts as to the
need for hospitalization, prognosis and medical interventions. The decision to start palliative care provision
in COPD patients is based on poor prognosis, but it is not clear when it should be started. Proper
and specialized palliative care in this patient population can limit hospital, Intensive Care Unit (ICU), and
emergency admissions.
A case of a patient with advanced COPD receiving palliative care and the treatment in the ICU is presented.
Due to pneumonia with permanent respiratory hypercapnia, the patient was hospitalized and qualified to
tracheostomy and invasive ventilation. In bronchofiberoscopy granulation tissue narrowing the airways
below the tracheotomy tube, confirmed by the CT scan. The patient was qualified for rigid bronchofiberoscopy
to widen the trachea. Antibiotic therapy with multidirectional pharmacological treatment was
provided at the ICU. The patient was discharged home in a fairly good general condition, on his breathing
with passive oxygen therapy, periodically requiring assisted mechanical ventilation, without carbon dioxide
retention, and with effective cough reflexes. Mechanical causes of respiratory failure in ventilated advanced
COPD patients should be considered. Short–time-intensive therapy treatment may improve the general
condition of ventilated advanced COPD patients.

Abstract

Chronic obstructive pulmonary disease (COPD) is the 3rd leading cause of death worldwide and 7th in
the classification of years of life lost or lived with disability. Indeed, COPD prevalence is still increasing.
Moreover, chronic respiratory failure in advanced COPD is one of the most common indications for palliative
care. The deterioration of general health, including respiratory failure, raises many doubts as to the
need for hospitalization, prognosis and medical interventions. The decision to start palliative care provision
in COPD patients is based on poor prognosis, but it is not clear when it should be started. Proper
and specialized palliative care in this patient population can limit hospital, Intensive Care Unit (ICU), and
emergency admissions.
A case of a patient with advanced COPD receiving palliative care and the treatment in the ICU is presented.
Due to pneumonia with permanent respiratory hypercapnia, the patient was hospitalized and qualified to
tracheostomy and invasive ventilation. In bronchofiberoscopy granulation tissue narrowing the airways
below the tracheotomy tube, confirmed by the CT scan. The patient was qualified for rigid bronchofiberoscopy
to widen the trachea. Antibiotic therapy with multidirectional pharmacological treatment was
provided at the ICU. The patient was discharged home in a fairly good general condition, on his breathing
with passive oxygen therapy, periodically requiring assisted mechanical ventilation, without carbon dioxide
retention, and with effective cough reflexes. Mechanical causes of respiratory failure in ventilated advanced
COPD patients should be considered. Short–time-intensive therapy treatment may improve the general
condition of ventilated advanced COPD patients.

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Keywords

Chronic Obstructive Pulmonary Disease (COPD), Intensive Care Unit (ICU), non-invasive ventilation (NIV), palliative care, respiratory failure

About this article
Title

Advanced COPD in a patient treated in the Intensive Care Unit

Journal

Palliative Medicine in Practice

Issue

Vol 14, No 2 (2020)

Article type

Case report

Pages

130-134

Published online

2020-05-16

Page views

578

Article views/downloads

720

DOI

10.5603/PMPI.2020.0013

Bibliographic record

Palliat Med Pract 2020;14(2):130-134.

Keywords

Chronic Obstructive Pulmonary Disease (COPD)
Intensive Care Unit (ICU)
non-invasive ventilation (NIV)
palliative care
respiratory failure

Authors

Urszula Kościuczuk
Ewa Tałałaj
Piotr Jakubów
Adam Łukasiewicz

References (15)
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  2. Henoch I, Strang P, Löfdahl CG, et al. Equal palliative care for patients with COPD? A nationwide register study. Ups J Med Sci. 2019; 124(2): 140–147.
  3. Almagro P, Yun S, Sangil A, et al. Palliative care and prognosis in COPD: a systematic review with a validation cohort. Int J Chron Obstruct Pulmon Dis. 2017; 12: 1721–1729.
  4. Gadoud A, Kane E, Oliver SE, et al. Palliative care for non-cancer conditions in primary care: a time trend analysis in the UK (2009-2014). BMJ Support Palliat Care. 2020 [Epub ahead of print].
  5. Storre JH, Matrosovich E, Ekkernkamp E, et al. Home mechanical ventilation for COPD: high-intensity versus target volume noninvasive ventilation. Respir Care. 2014; 59(9): 1389–1397.
  6. Weber C, Stirnemann J, Herrmann FR, et al. Can early introduction of specialized palliative care limit intensive care, emergency and hospital admissions in patients with severe and very severe COPD? a randomized study. BMC Palliat Care. 2014; 13: 47.
  7. Vermylen JH, Szmuilowicz E, Kalhan R. Palliative care in COPD: an unmet area for quality improvement. Int J Chron Obstruct Pulmon Dis. 2015; 10: 1543–1551.
  8. Brożek B, Damps-Konstańska I, Pierzchała W, et al. End-of-life care for patients with advanced lung cancer and chronic obstructive pulmonary disease: survey among Polish pulmonologists. Pol Arch Intern Med. 2019; 129(4): 242–252.
  9. Koulenti D, Parisella FR, Xu E, et al. The relationship between ventilator-associated pneumonia and chronic obstructive pulmonary disease: what is the current evidence? Eur J Clin Microbiol Infect Dis. 2019; 38(4): 637–647.
  10. Gäbler M, Ohrenberger G, Funk GC. Treatment decisions in end-stage COPD: who decides how? A cross-sectional survey of different medical specialties. ERJ Open Res. 2019; 5(3).
  11. Brill SE, Wedzicha JA. Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2014; 9: 1241–1252.
  12. Wiles SP, Aboussouan LS, Mireles-Cabodevila E. Noninvasive positive pressure ventilation in stable patients with COPD. Curr Opin Pulm Med. 2020; 26(2): 175–185.
  13. Criner GJ, Dreher M, Hart N, et al. COPD Home Oxygen Therapy and Home Mechanical Ventilation: Improving Admission-Free Survival in Persistent Hypercapnic COPD. Chest. 2018; 153(6): 1499–1500.
  14. Gadre SK, Duggal A, Mireles-Cabodevila E, et al. Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive pulmonary disease (COPD). Medicine (Baltimore). 2018; 97(17): e0487.
  15. Wytyczne Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii określające zasady kwalifikacji oraz kryteria przyjęcia chorych do Oddziałów Anestezjologii i Intensywnej Terapii. http://www.anestezjologia.org.pl/.

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