{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T01:02:40Z","timestamp":1790643760005,"version":"4.1.0"},"reference-count":25,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Respir Crit Care Med"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Patients who suffer from chronic obstructive pulmonary disease (COPD) often experience deterioration of baseline respiratory symptoms, acute exacerbations of COPD (AECOPD), that become more frequent with disease progression. Based on symptom severity, approximately 20% of these patients will require hospitalization. The most common indicators for intensive care unit (ICU) admission have been found to be worsening or impending respiratory failure and hemodynamic instability. Bacterial and viral bronchial infections are the causative triggers in the majority of COPD exacerbations in the ICU, with a comprehensive assessment revealing them in 72% of cases. The distribution of bacterial pathogens involved in AECOPD requiring ICU admission show an increased incidence of gram-negative respiratory isolates, including Pseudomonas and Enterobacteriaceae spp., when compared with outpatient exacerbations. Evaluation of these patients requires careful attention to comorbid conditions. An effort to rapidly obtain lower respiratory samples for microbiological samples prior to initiation of antibiotics should be made as adequate samples can guide subsequent modifications of antibiotic treatment if the clinical response to empiric treatment is poor. Empiric antibiotic treatment should be promptly initiated in all patients with a major consideration for the choice being the presence of risk factors for Pseudomonas infection. Evaluation of clinical response at 48 to 72\u2009hours is crucial, and total duration of antibiotics of 5 to 7 days should be adequate.<\/jats:p>","DOI":"10.1055\/s-0040-1708837","type":"journal-article","created":{"date-parts":[[2020,8,11]],"date-time":"2020-08-11T22:52:14Z","timestamp":1597186334000},"page":"830-841","source":"Crossref","is-referenced-by-count":11,"title":["Chronic Obstructive Pulmonary Disease in the Intensive Care Unit: Antibiotic Treatment of Severe Chronic Obstructive Pulmonary Disease Exacerbations"],"prefix":"10.1055","volume":"41","author":[{"given":"Nita","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Swedish Hospital, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Haley","sequence":"additional","affiliation":[{"name":"Department of Medicine, University at Buffalo, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Sethi","sequence":"additional","affiliation":[{"name":"Department of Medicine, University at Buffalo, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,8,11]]},"reference":[{"issue":"22","key":"ref2","doi-asserted-by":"crossref","first-page":"2355","DOI":"10.1056\/NEJMra0800353","article-title":"Infection in the pathogenesis and course of chronic obstructive pulmonary disease","volume":"359","author":"S Sethi","year":"2008","journal-title":"N Engl J Med"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1111\/j.1440-1843.2010.01722.x","article-title":"Prevalence of viral infection detected by PCR and RT-PCR in patients with acute exacerbation of COPD: a systematic review","volume":"15","author":"A Mohan","year":"2010","journal-title":"Respirology"},{"issue":"02","key":"ref5","first-page":"217","article-title":"Characteristics of COPD patients admitted to the ICU of a referral hospital for respiratory diseases in Brazil","volume":"37","author":"M P Pincelli","year":"2011","journal-title":"J Bras Pneumol"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"884A","DOI":"10.1016\/j.chest.2016.08.984","article-title":"ICU admission rate among patients with acute exacerbation of COPD: what are predictors for ventilator support?","volume":"150","author":"A Sadigov","year":"2016","journal-title":"Chest"},{"issue":"13","key":"ref7","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1056\/NEJMcp012477","article-title":"Clinical practice. 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