Abstract
Chronic obstructive pulmonary disease (COPD) is the most common cause of chronic respiratory
insufficiency in the developed world today and is a common underlying etiology for
acute ventilatory failure. Until recently, invasive positive pressure ventilation
was the most commonly used ventilatory modality in patients with respiratory failure
caused by COPD. Complications of barotrauma and respiratory infection occur commonly
when invasive ventilation is used, and costs of care can be high. In recent years,
newer pathophysiological insights and the increasing use of noninvasive ventilation
have changed the ventilatory management of COPD. The following reviews the respiratory
pathophysiology of COPD that is relevant to mechanical ventilation, discusses the
evidence supporting use and selection of patients for noninvasive ventilation, makes
recommendations for the optimal management of patients receiving invasive mechanical
ventilation, and examines evidence on outcomes.
Key Words:
Mechanical ventilation - positive end expiratory pressure
