Standardisation of Clinical Assessment, Management and Follow-Up of Acute Hospitalised Exacerbation of COPD: A Europe-Wide Consensus.
Standardisation of Clinical Assessment, Management and Follow-Up of Acute Hospitalised Exacerbation of COPD: A Europe-Wide Consensus.
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DOI：
10.2147/copd.s287705
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发表时间：
2021
影响因子：
2.8
通讯作者：
Bafadhel M
中科院分区：
文献类型：
--
作者：
Ramakrishnan S;Janssens W;Burgel PR;Contoli M;Franssen FME;Greening NJ;Greulich T;Gyselinck I;Halner A;Huerta A;Morgan RL;Quint JK;Vanfleteren LEGW;Vermeersch K;Watz H;Bafadhel M
尽管因急性加重住院是发病率和死亡率的高风险事件，但全球对COPD急性加重住院的评估和管理几乎没有共识。我们的目的是建立一个共识列表的症状，生理指标，临床评分，患者问卷调查和调查，将在住院COPD急性加重和随访时获得。进行了一项改良的德尔菲在线调查，对COPD急性加重住院和随访时的措施的重要性、可行性和频率达成了预先定义的共识。来自18个国家的25名COPD专家参与了所有三轮调查。专家们一致认为，需要详细的病史和检查。专家们还就需要哪些治疗以及应该多久提供这些治疗达成了一致。专家建议，应在入院后4小时内测量全血细胞计数、肾功能、C反应蛋白和心脏血液生物标志物（BNP和肌钙蛋白），并在急性加重和随访时进行改良医学研究理事会呼吸困难量表（mMRC）和COPD评估试验（CAT）。专家鼓励COPD临床医生在住院时，如果有指征，强烈考虑讨论姑息治疗。这份欧洲范围内的共识文件是首次尝试对因COPD急性加重住院患者的评估和护理进行评估。这应被视为建立关于因COPD急性加重住院患者的知识和证据的起点。
Despite hospitalization for exacerbation being a high-risk event for morbidity and mortality, there is little consensus globally regarding the assessment and management of hospitalised exacerbations of COPD. We aimed to establish a consensus list of symptoms, physiological measures, clinical scores, patient questionnaires and investigations to be obtained at time of hospitalised COPD exacerbation and follow-up. A modified Delphi online survey with pre-defined consensus of importance, feasibility and frequency of measures at hospitalisation and follow-up of a COPD exacerbation was undertaken. A total of 25 COPD experts from 18 countries contributed to all 3 rounds of the survey. Experts agreed that a detailed history and examination were needed. Experts also agreed on which treatments are needed and how soon these should be delivered. Experts recommended that a full blood count, renal function, C-reactive protein and cardiac blood biomarkers (BNP and troponin) should be measured within 4 hours of admission and that the modified Medical Research Council dyspnoea scale (mMRC) and COPD assessment test (CAT) should be performed at time of exacerbation and follow-up. Experts encouraged COPD clinicians to strongly consider discussing palliative care, if indicated, at time of hospitalisation. This Europe-wide consensus document is the first attempt to standardise the assessment and care of patients hospitalised for COPD exacerbations. This should be regarded as the starting point to build knowledge and evidence on patients hospitalised for COPD exacerbations.