Extracorporeal lung assist might avoid invasive ventilation in exacerbation of COPD.

Acute exacerbation of chronic obstructive pulmonary disease (COPD) requiring invasive mechanical ventilation (IMV) is associated with a very poor prognosis. Therefore noninvasive mechanical ventilation (NIV) with avoidance of endotracheal intubation should be preferred. However, NIV can fail and result in severe respiratory acidosis. If IMV becomes mandatory, the development of pulmonary dynamic hyperinflation with subsequent barotrauma and circulatory failure is the main pathophysiological alteration.