Complications
Patients who are ventilated are at high risk of infection. May be due to aspiration following intubation and/or related to bypassing normal anatomic structures involved in host defense.
Antibiotic-associated colitis, which may be due to Clostridium difficile, is a recognized complication of exposure to antibiotics.
Occurs due to mechanical ventilation, and is the development of extra-alveolar air. Careful use of ventilator settings, including use of lower tidal volumes, faster inspiratory flow rates, and monitoring airway pressures may help prevent the occurrence of this complication.
Occurs due to increased intrathoracic pressure and increased dynamic hyperinflation, leading to decreased venous return to the heart, often in conjunction with relative volume depletion and/or use of anxiolytic and/or narcotic medications.
The risk of myocardial infarction, arrhythmias, heart failure, and stroke increases during an acute exacerbation, particularly in patients requiring hospitalization.[1] In one UK primary care database of more than 200,000 patients, approximately 150,000 had an exacerbation between 2014 and 2020, and 40,000 cardiovascular events were recorded. The increased risk of a cardiovascular event was most evident in patients with severe exacerbations during the two weeks following the exacerbation; risk was highest slightly later in patients with moderate exacerbations, but risk in all patients remained raised after 1 year.[128] Awareness of increased risk, intervention, and treatment is critical to prevent cardiovascular events.
This may develop as a result of increased hypoxic vasoconstriction due to exacerbation-induced hypoxemia. The resulting increase in pulmonary vascular resistance and/or pulmonary artery pressure can lead to acute right heart failure. Elevated jugular venous pressure, hepatojugular reflux, peripheral edema, and relative hypotension may be present.
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