Criteria
Both Global Initiative for Chronic Obstructive Lung Disease (GOLD) and National Institute for Health and Care Excellence (NICE) guidelines stratify exacerbations into mild, moderate, and severe, based on the management required:[1][90][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) or BAP-65.[101] [ BAP-65 prediction of in-hospital mortality and need for mechanical ventilation in COPD Opens in new window ]
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 20-30 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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