Enfrentando desafios na DPOC: gerenciamento na UTI

A exacerbacao da DPOC e causa frequente de admissao em UTI e de necessidade de ventilacao mecânica. Criterios para o diagnostico da insuficiencia respiratoria devem ser prontamente avaliados. O uso de oxigenoterapia e imperativo a admissao. Se possivel, a ventilacao nao invasiva deve ser o suporte ventilatorio de primeira escolha; no contrario, deve-se considerar a intubacao orotraqueal. A estrategia ventilatoria mecânica deve priorizar a reversao da hiperinsuflacao dinâmica. A fase de transicao para o desmame requer uso judicioso da pressure support ventilatione, novamente, o emprego da ventilacao nao invasiva em casos com desmame dificil e hipercapnia persistente. Em paralelo, recomenda-se o uso liberal de broncodilatadores por via inalatoria, administracao de corticosteroides sistemicos e antibioticoterapia de amplo espectro. Nos casos de falha de desmame, uma abordagem multifatorial e obrigatoria com a investigacao e o tratamento da doenca de base e de multiplas comorbidades. O prognostico e reservado e o acompanhamento sequencial por especialista e recomendado ante a alta taxa de recidivas do quadro (AU) Exacerbations of COPD constitute a common cause of ICU admission and of a need of mechanical ventilation. Criteria for the diagnosis of acute respiratory failure should be promptly evaluated in the emergency room. The use of oxygen is imperative at admission. If not contra-indicated, noninvasive ven tilation should be the ventilatory support strategy of first choice; otherwise, endotracheal intubation should be considered. The mechanical ventilation strategy should prioritize the reversal of dynamic hyperinflation. The transition to weaning requires judicious use of pressure support ventilation and, again, the use of noninvasive ventilation in difficult-t o-wean patients with persistent hypercapnia. In parallel, pharmacological interventions, such as the liberal use of inhaled bronchodilators, systemic corticosteroids, and broad-spectrum antibiotics, are recommended. In cases of failure-to-wean, a multifactorial approach is required in order to assess and treat the underlying disease and multiple comorbidities. The prognosis is poor, and sequential follow up by a specialist is recommended becauseof the high rate of recurrence of this condition(AU)