Emergency department management of exacerbation of chronic obstructive pulmonary disease: audit of compliance with evidence-based guidelines

作者：Considine J^*; Botti M; Thomas S

来源：Internal Medicine Journal, 2011, 41(1A): 48-54.

DOI：10.1111/j.1445-5994.2009.02065.x

• chronic obstructive pulmonary disease (COPD)
• evidence-based practice
• emergency medicine

Background: Emergency departments (ED) play a key role in management of exacerbation of chronic obstructive airways disease (COPD). Current guidelines for management of exacerbation of COPD showed highest levels of evidence (Level A and B) were related to use of medications and non-invasive positive pressure ventilation (NIPPV).
Aims: The aim of this study was to examine compliance with high level evidence for management of exacerbation of COPD during the first 4 h of ED care.
Methods: A retrospective medical record audit was conducted at four public and one private ED in Melbourne, Australia. Participants were adult patients with COPD presenting to the ED with a primary complaint of shortness of breath from July 2006 to July 2007. Outcome measures were compliance with evidence-based recommendations regarding use of bronchodilators, methylxanthines, steroids and NIPPV.
Results: Of 273 patients in this study, 72.4% received short-acting beta-agonist bronchodilators, 37.8% received an inhaled short-acting anticholinergic medication and 56.6% received systemic steroid therapy. NIPPV was used in 21 patients, 15 of whom had documentation of acidosis and/or hypercapnia).
Conclusions: There was variation in the use of high level evidence for the ED management of exacerbation of COPD. The highest rate of compliance was non-use of methylxanthines and the greatest deficit was poor compliance with evidence related to NIPPV. There was also scope for improvement in the use of bronchodilators and systemic steroids.

• 出版日期2011-1
• 单位迪肯大学