Synonyms for COPD: COLD, CORD
Patient selection: COPD with pneumonia requiring admission to the intensive care unit (ICU)
Risk factors for IBPA:
(1) therapy with > 3 kinds of antibiotics prior to the ICU admission
(2) accumulated dose of corticosteroids > 350 mg prednisone
(3) other immunosuppression or immunodeficiency (not listed in paper)
Clinical features that should raise the possibility of IBPA:
(1) APACHE II score > 18 (presumably on admission to the ICU)
(2) fever > 38.5°C
(3) wheeze without exertion
(4) dry rales
(5) organ failures (hypotension, renal failure, respiratory failure, hepatic dysfunction, coagulopathy)
(6) rapid progression of pulmonary infiltrate to consolidation
(7) failure to respond to antibiotics and corticosteroid therapy
Bronchoscopic findings suggesting IBPA:
(1) bronchospasm
(2) "ropy" sputum
(3) bronchial plaques and/or pseudomembranes
