Late stage of emphysema

lung volume reduction surgery has shown some success in treating patients with severe emphysema.
just a thought

Lung transplantation for COPD/Emphysema really doesn't improve survival, but is more for quality of life issues. Really, it's all about medication management, and staying on oxygen to keep on an even keel. About all you can do.

We just had a case study on an exacerbation of COPD to illustrate vent orders and decisions...........the gist of it, you basically intubate and stabilize to get them over the "hump", then you try to wean them back to their normal levels since they are relying on pCO2 levels to breathe, and eventually off the vent. But yeah mostly you just treat them by symptoms and try to make them comfortable.

Lady Tokimi said:

Okay, say your patient has late stage emphysema. Would it be a good idea to put them on a respirator??

Any thoughts?

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My greatest concern would be oxygenating the blood so that perfusion adequately meets metabolic demands. My thought would be to increase cardiac output via increased preload by increasing fluid volume and providing blood constituents like plasma adding additional hemoglobin and thus 02 content.

Harvard cited that oxygen therapy is highly beneficial, however there are risks associated with the accumulation of excessive carbon dioxide in the blood. Find the link to the article below. I read over it (pretty interesting).

http://hmiworld.org/hmi/past_issues/July_August_2003/around_emphys.html

this is an answer from personal experience, not from a medical book or anything. My mom had COPD, she caught a staph infection in the hospital and because of her high fever they intubated her and I was thinking this was a really bad idea. She was oxygen dependent and everything. I spoke to the ICU doctor and he basically said that you avoid the intubation at all costs, but often times the benefit is much more then the risk. I was concerned they would never be able to get her off the respirator and if she survived the infection, that it would be the begining of then end for her anyway. However, the doctor said thhat they do get people off of them in her condition. I don;t think it would be a good idea to put someone on a ventilator just because breathing is very difficult, oxygen therapy is pretty good for that I think. This may not be relavent or informative, but just thought I would add my two cents.

DocGina said:

My greatest concern would be oxygenating the blood so that perfusion adequately meets metabolic demands. My thought would be to increase cardiac output via increased preload by increasing fluid volume and providing blood constituents like plasma adding additional hemoglobin and thus 02 content.

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What you have in this situation is chronic pulmonary vasoconstriction, however. Adding preload/circulating fluid volume could trigger heart failure, and we must remember that these patients are very rarely only COPD cases, as there is always a modicum of heart failre, renal disease, hepatic injury associated. Also, even if not clinically detectable, right heart strain is associated. The mainstay of treatment must be to saturate the existing hemoglobin (which will already likely be increased) with external O2 sources. Ventilation is definitely indicated in cases where the patient is in impending/existing respiratory distress, and supplemental oxygen (i.e. via mask) will only get you sued, I believe.

However, to be intubated for just a fever might be a little over the top. I would imagine there were other concerns at play.

With my own experiences from my dad, the two biggest treatments have been to get him retired from his job as a teacher (where the initial exposures to all kinds of chemicals/carcinogens/black mold/asbestos) took place, and continual oxygen therapy. Avoiding the exacerbations is the single most important goal, which is hard for somebody like my dad who continually pushes himself too hard.