Clinical concise review: Mechanical ventilation of patients with chronic obstructive pulmonary disease

Objective: To summarize the current literature on mechanical ventilation of patients with chronic obstructive pulmonary disease (COPD) using published data to augment commonly accepted principles of clinical practice. Data Source: A MEDLINE/PubMed search from 1966 to November 2006 using the search terms mechanical ventilation, respiratory failure, noninvasive positive pressure ventilation (NIPPY), and COPD, and weaning. Subsequent searches were done on more specific issues such as heliox. Additionally, prominent researchers in this field were interviewed for knowledge of ongoing or unpublished data and their clinical practice. Data Extraction and Synthesis: COPD is very common cause of respiratory failure and admission to the intensive care unit. Mechanical ventilation of patients with COPD presents a unique set of challenges compared with other patients. Care must be taken to avoid augmenting dynamic hyperinflation and acid/base disturbances resulting from chronic hypercapnic respiratory failure. Modalities such as NIPPY and helium/oxygen gas mixtures are increasingly being recognized for their ability to help prevent invasive ventilation and aid in getting patients off invasive ventilation. Conclusions: Despite decades of study, most of the principles of safe mechanical ventilation for patients with COPD such as low respiratory rates that maximize expiratory time and careful attention to air-trapping still hold true to this day. NIPPY appears to be the most important new modality in reducing the mortality, morbidity and incidence of invasive mechanical ventilation.