Advanced COPD in a patient treated in the Intensive Care Unit

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.