From the Guidelines
The initial treatment for a patient with basilar airspace disease should focus on oxygen therapy, with the use of a reservoir mask at 15 L/min if the initial SpO2 is below 85%, otherwise nasal cannulae or simple face mask at 2–6 L/min or 5–10 L/min, respectively, as recommended by the BTS guideline for oxygen use in adults in healthcare and emergency settings 1.
Key Considerations
- The initial oxygen saturation target range should be 94–98% for patients not at risk of hypercapnic respiratory failure, unless they have coexisting COPD or other risk factors for hypercapnic respiratory failure, in which case the target range should be 88–92% pending blood gas results 1.
- If oximetry is not available, oxygen should be given as above until oximetry or blood gas results are available, and the patient should be assessed by senior medical staff if the desired saturation range cannot be maintained with initial oxygen therapy 1.
- The choice of oxygen delivery device may need to be adjusted based on the patient's response to treatment and their underlying condition, with consideration of changing to a reservoir mask if necessary to achieve the target oxygen saturation range 1.
Additional Recommendations
- Patients with basilar airspace disease who are hypoxaemic may require oxygen therapy in addition to treatment of the underlying cause of their condition, such as pneumonia or pulmonary embolism 1.
- In cases where the patient has a pneumothorax, aspiration or drainage may be necessary if they are hypoxaemic, and oxygen therapy should be used to achieve 100% saturation if admission for observation is required 1.
- For patients with pleural effusions, treatment should focus on draining the effusion in addition to providing oxygen therapy if they are hypoxaemic 1.
From the Research
Basilar Airspace Disease Treatment
The initial treatment for a patient with basilar airspace disease is not explicitly stated in the provided studies. However, some information can be gathered from the studies:
- The treatment of airspace disease, in general, depends on the underlying cause, which can be infectious, inflammatory, or neoplastic 2.
- For chronic obstructive pulmonary disease (COPD) exacerbations, a study suggests that azithromycin may be beneficial in reducing treatment failure when added to standard care 3.
- In cases of suspected infection, empiric antimicrobial therapy is often necessary, and the choice of antibiotic should consider the likely etiologies and anticipated resistance patterns 4.
- For aspiration pneumonia, a study found that ceftriaxone is a useful option and is not inferior to broad-spectrum antibiotics like piperacillin-tazobactam or carbapenems 5.
Key Considerations
Some key considerations in the treatment of basilar airspace disease include:
- Identifying the underlying cause of the disease to guide treatment 2, 6
- Using computed tomography (CT) scans to identify characteristic imaging findings 2, 6
- Considering the use of antimicrobial therapy, especially in cases of suspected infection 4, 5
- Tailoring treatment based on the patient's response and susceptibility test results 4