CPAP for COPD ?

medichopeful

NRP, ICU RN, CCRN, CEN
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My last round of research on this topic revealed that CPAP -MAY- help in COPD exacerbation but the exact physiology behind why it works was still unclear.

What I train our folks here is this;

CPAP may be an intermediate step before intubation in COPD patients, but you need to be ready and willing to move on if it doesn't help (pre-plan you drugs, stage your equipment, and assess the airway difficulty). Anecdotally here - mag sulfate infusions seem to do a better job of turning these folks around than CPAP, and I think the majority of our department has shifted in that direction as the intermediate step before RSI.
My understanding (and of course, I could be wrong) is that mag isn't really useful for COPD, only asthma (due to the fact that in COPD, the damage/constriction is chronic. In asthma, the constriction is more acute, thus responds better to mag).

I've only initiated CPAP once prehospitally on a COPD patient, and I can say that the improvement was drastic on just 5 of PEEP. Went from gasping to sleeping/resting (not the "oh crap" resting of a respiratory patient, a legitimate "oh, they look comfortable!").
 
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NPO

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My understanding (and of course, I could be wrong) is that mag isn't really useful for COPD, only asthma (due to the fact that in COPD, the damage/constriction is chronic. In asthma, the constriction is more acute, thus responds better to mag).

I've only initiated CPAP once prehospitally on a COPD patient, and I can say that the improvement was drastic on just 5 of PEEP. Went from gasping to sleeping/resting (not the "oh crap" resting of a respiratory patient, a legitimate "oh, they look comfortable!").
I echo this.

Mag helps to relax the bronchioles, but this is much more effective in asthmatics who have elasticity than COPDers who have very little elasticity left.

I have used CPAP quite a bit prehospitaly (with disposable kits), and more recently have been using BiPAP via a ventilator. Both COPD and CHF patients tend to improve dramatically very quick. Some data I read recently in preparation for a CPAP presentation cited 90 seconds for notable improvement in many patients.

Anecdotally, I've noticed CHF patients tend to have worse anxiety relating to CPAP, I assume it has to do with feeling like they are drowning. COPDers tend to have far better compliance with CPAP/BIPAP in my experience.
 

Akulahawk

EMT-P/ED RN
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Where I work, I tend to be pretty aggressive with suggesting CPAP or BiPAP in the COPD exacerbation patient. Since I also know they can do in-line nebs, I will usually suggest that as well. It really is one of those "you'll know when you see it" kind of things. Most of the patients that I see only get breathing treatments, a steroid, and sometimes a mag infusion. It also doesn't take long to recognize when a patient isn't responding well to CPAP or BiPAP. If you see that, it's often a good idea to at least consider getting ready to intubate that patient.
 

ZombieEMT

Chief Medical Zombie
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Here in New Jersey, CPAP for BLS is pretty new. While many BLS agencies have it, it is not a state requirement yet. In the agencies that I work, our protocols are pretty specific. In suspected COPD patients, our protocol is to administer CPAP with a PEEP of 5, or 10 for suspected PE. I can say that I have applied CPAP for a COPD in severe distress. The unfortunate thing, is that the local ALS systems seem to think its not an option. The problem is their protocol generally calls for that albuterol/duo neb first, and CPAP almost as a last result. For BLS, that is our first and last resort (next to high flow oxygen). New Jersey has finally allowed BLS to "assist" with a prescribed neb but not to carry, meaning CPAP is normally a good option for us.
 

truetiger

Forum Asst. Chief
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Perfect subset of patients to use BiPAP in.......we carry the ReVel vent and use it quite often.
 
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