[Ventilation strategies for chronic obstructive pulmonary disease]

M Stein, M Joannidis
Medizinische Klinik, Intensivmedizin und Notfallmedizin 2012, 107 (8): 613-21
Chronic obstructive pulmonary disease (COPD) is considered to be one of the most frequent pulmonary diseases in industrialized countries. Non-invasive ventilation (NIV) is the first choice therapy in acute exacerbations of chronic hypercapnic respiratory failure (AE-COPD). Effective delivery of NIV requires a specialized interdisciplinary team with sufficient monitoring. NIV is delivered as assisted positive pressure ventilation where high inspiratory flow and peak pressure are required. The external positive end expiratory pressure (PEEP) should be adjusted to the intrinsic PEEP. Criteria of success are improvement in the clinical, especially neurological condition as well as improvement of pH and PaCO(2). Patients with a pH between 7.25 and 7.35 have demonstrated most benefit from NIV. In cases of patients not responding to NIV endotracheal intubation should be initiated in a timely manner. Assisted ventilation modes are preferred over controlled ventilation modes in intubated COPD patients. Settings of respirators have to be aimed at a reduction of intrinsic PEEP and dynamic hyperinflation. This includes sufficient external PEEP, long expiration times and low respiratory frequencies even allowing for permissive hypercapnia.

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