Criteria

Both GOLD and NICE guidelines stratify exacerbations into mild, moderate, and severe, based on the management required:[1][83] Assess severity to determine where and how to treat the patient[Figure caption and citation for the preceding image starts]: Assess severity to determine where and how to treat the patientCreated by the BMJ Knowledge Centre based on GOLD and NICE guidelines [Citation ends].

In hospitalised patients, assess the severity of the exacerbation using a prognostic score, such as DECAF (Dyspnoea, Eosinopenia, Consolidation, Acidaemia, and atrial Fibrillation)[92] or BAP-65.[ BAP-65 prediction of in-hospital mortality and need for mechanical ventilation in COPD ]

  • The score will indicate which patients are likely to benefit from early intervention, such as non-invasive ventilation.

Further stratify hospitalised patients based on their clinical signs.[1] 

  • No respiratory failure 

    • Respiratory rate 20 to 30 breaths/minute.

    • No use of accessory respiratory muscles.

    • No change in mental status.

    • Supplemental oxygen given via Venturi mask up to 28% to 35% inspired oxygen (FiO2) restores oxygen saturations.

      • Ensure that there is no evidence of hypercapnia before moving to higher concentrations of oxygen.

      • Perform ongoing assessment of arterial blood gas (ABG).

      • Document the FiO2 or O2 flow rate.

    • No increase in PaCO2

  • Acute respiratory failure – non-life threatening

    • Respiratory rate >30 breaths/minute.

    • Using accessory respiratory muscles.

    • No change in mental status.

    • Hypoxaemia improves when supplemental oxygen at higher concentrations is given via Venturi mask.

      • You must ensure that there is no evidence of hypercapnia before moving to higher concentrations of oxygen.

      • Perform ongoing assessment of ABGs.

      • Document the FiO2 or O2 flow rate.

    • PaCO2 increased compared with baseline or elevated approximately 6.7 kPa (50-60 mmHg).

  • Acute respiratory failure – life threatening 

    • Respiratory rate >30 breaths/minute.

    • Using accessory respiratory muscles.

    • Acute changes in mental status.

    • Hypoxaemia not improved with supplemental oxygen via Venturi mask or increased FiO2.

      • You must ensure that there is no evidence of hypercapnia before moving to higher concentrations of oxygen.

      • Perform ongoing assessment of ABGs.

      • Document the FiO2 or O2 flow rate.

    • PaCO2 increased compared with baseline or elevated approximately 8 kPa (>60 mmHg) or acidosis present.

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