Clinics in Chest Medicine

MECHANICAL VENTILATION IN OBSTRUCTIVE LUNG DISEASE James W. Leatherman MD Severe airflow obstruction is one of the most common causes of acute respiratory failure encountered in medical ICUs. Although most patients with life-threatening exacerbations of asthma or chronic obstructive pulmonary disease (COPD) respond to a noninvasive approach, in certain instances, endotracheal intubation and mechanical ventilatory support are necessary for survival. Although often lifesaving, mechanical ventilation of patients with severe airflow obstruction is associated with many complications that may result in serious morbidity or even death.69 An important cause of ventilator-related complications is excessive dynamic pulmonary hyperinflation, [ ] 72 a process that occurs primarily in the setting of severe airflow obstruction. In addition, patients may suffer complications related to the drugs used to treat underlying airway disease or to facilitate ventilatory support by inducing relaxation of respiratory muscles. [ ] 44 [ ] 46