Intensive Care Medicine

, Volume 24, Issue 9, pp 898–910 | Cite as

Mechanical ventilation of the patient with severe chronic obstructive pulmonary disease



Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Pingleton SK (1988) Complications of acute respiratory failure. Am Rev Respir Dis 137: 1463–1493PubMedGoogle Scholar
  2. 2.
    Pierson DJ (1990) Complications of mechanical ventilation. Curr Pulmonol 11:19–46Google Scholar
  3. 3.
    Brochard L, Mancebo J, Wysocki M, et al (1995) Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 333: 817–822PubMedCrossRefGoogle Scholar
  4. 4.
    Weiss SM, Hudson LD (1994) Outcome from respiratory failure. Crit Care Clin 10:197–215PubMedGoogle Scholar
  5. 5.
    Curran FJ (1981) Night ventilation by body respiratory for patients in chronic respiratory failure due to late stage Duchenne muscular dystrophy. Arch Phys Med Rehabil 62: 270–274PubMedGoogle Scholar
  6. 6.
    Garay SM, Turino GM, Goldring RM (1981) Sustained reversal of chronic hypercapnia in patients with alveolar hypoventilation syndromes: long-term maintenance with noninvasive nocturnal mechanical ventilation. Am J Med 70: 269–274PubMedCrossRefGoogle Scholar
  7. 7.
    Goldstein RS, Molotiu N, Skrastins R, et al (1987) Reversal of sleep-induced hypoventilation and chronic respiratory failure by nocturnal negative-pressure ventilation in patients with restrictive ventilatory impairment. Am Rev Respir Dis 135:1049–1055PubMedGoogle Scholar
  8. 8.
    Shapiro SH, Ernst P, Gray-Donald K, et al (1992) Effect of negative-pressure ventilation in severe chronic obstructive pulmonary disease. Lancet 340: 1425–1429PubMedCrossRefGoogle Scholar
  9. 9.
    Corrado A, De Paola E, Gorini M, et al (1996) Intermittent negative-pressure ventilation in the treatment of hypoxic hypercapnic coma in chronic respiratory insufficiency. Thorax 51: 1077–1082PubMedCrossRefGoogle Scholar
  10. 10.
    Corrado A, Gorini M, Villella G, et al (1996) Negative-pressure ventilation in the treatment of acute respiratory failure: an old noninvasive technique reconsidered. Eur Respir J 9: 1531–1544PubMedCrossRefGoogle Scholar
  11. 11.
    Udwadia ZF, Santis GK, Steven MH, Simonds AK (1992) Nasal ventilation to facilitate weaning in patients with chronic respiratory insufficiency. Thorax 47: 715–718PubMedCrossRefGoogle Scholar
  12. 12.
    Restrick LJ, Scott AD, Ward EM, et al (1993) Nasal intermittent positive-pressure ventilation in weaning intubated patients with chronic respiratory disease from assisted intermittent, positive-pressure ventilation. Respir Med 87: 199–204PubMedCrossRefGoogle Scholar
  13. 13.
    Nava S, Ambrosino N, Clini E, Prato M, Orlando G, Vitacca M, et al (1998) Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial. Ann Intern Med 128: 721–728PubMedGoogle Scholar
  14. 14.
    Ferguson GT, Gilmartin M (1995) CO2 rebreathing during BiPAP ventilatory assistance. Am J Respir Crit Care Med 151: 1126–1135PubMedGoogle Scholar
  15. 15.
    Lofaso F, Brochard L, Touchard D, et al (1995) Evaluation of carbon dioxide rebreathing during pressure support ventilation with airway management system (BiPAP) devices. Chest 108: 772–778PubMedCrossRefGoogle Scholar
  16. 16.
    Hillberg RE, Johnson DC (1997) Noninvasive ventilation. N Engl J Med 337: 1746–1752PubMedCrossRefGoogle Scholar
  17. 17.
    Kramer N, Meyer TJ, Meharg J, et al (1995) Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 151: 1799–1806PubMedGoogle Scholar
  18. 18.
    Brochard L, Isabey D, Piquet J, et al (1990) Reversal of acute exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask. N Eng J Med 323: 1523–1530CrossRefGoogle Scholar
  19. 19.
    Goldberg P, Reissmann H, Maltais F, et al (1995) Efficacy of noninvasive CPAP in COPD with acute respiratory failure. Eur Respir J 8:1894–1900PubMedCrossRefGoogle Scholar
  20. 20.
    Confalonieri M, Aiolfi S, Gandola L, et al (1994) Severe exacerbations of chronic obstructive pulmonary disease treated with BiPAP by nasal mask. Respiration 61: 310–316PubMedCrossRefGoogle Scholar
  21. 21.
    Meduri GU, Turner RE, Abou-Shala N, et al (1996) Noninvasive positive pressure ventilation via face mask: first-line intervention in patients with acute hypercapnic and hypoxemic respiratory failure. Chest 109:179–193PubMedCrossRefGoogle Scholar
  22. 22.
    Confalonieri M, Parigi P, Scartabellati A, et al (1996) Noninvasive mechanical ventilation improves the immediate and long-term outcome of COPD patients with acute respiratory failure. Eur Respir J 9: 422–430PubMedCrossRefGoogle Scholar
  23. 23.
    Vitacca M, Clini E, Rubini F, et al (1996) Non-invasive mechanical ventilation in severe chronic obstructive lung disease and acute respiratory failure: short-and long-term prognosis. Intensive Care Med 22: 94–100PubMedCrossRefGoogle Scholar
  24. 24.
    Bott J, Carroll MP, Conway JH, et al (1993) Randomized controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet 341: 1555–1557PubMedCrossRefGoogle Scholar
  25. 25.
    Pierson DJ (1992) Clinical approach to the patient with acute ventilatory failure. In: Pierson DJ, Kacmarek RM (eds) Foundations of respiratory care. Churchill Livingstone, New York, pp 707–719Google Scholar
  26. 26.
    Muir JF, Levi-Valensi P (1987) When should patients with COPD be ventilated? Eur J Respir Dis 70: 135–139PubMedGoogle Scholar
  27. 27.
    Meduri GU (1996) Non-invasive positive-pressure ventilation in patients with acute respiratory failure. Clin Chest Med 17: 513–565PubMedCrossRefGoogle Scholar
  28. 28.
    American Respiratory Care Foundation: Concensus conference: Noninvasive positive pressure ventilation-preamble and concensus statement. Respir Care 42: 364–396Google Scholar
  29. 29.
    Simonds AK (1996) Negative-pressure ventilation in acute hypercapnic chronic obstructive pulmonary disease. Thorax 51: 1069–1070PubMedCrossRefGoogle Scholar
  30. 30.
    Rosen RL, Bone RC (1990) Treatment of acute exacerbations of chronic obstructive pulmonary disease. Med Clin North Am 74: 691–700PubMedGoogle Scholar
  31. 31.
    Haluzska J, Chartrand DA, Grassino AE, et al (1990) Intrinsic PEEP and arterial PaC02 in stable patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 141: 1194–1197Google Scholar
  32. 32.
    Feihl F, Perret C (1994) Permissive hypercapnia. How permissive should we be? Am J Respir Crit Care Med 150: 1722–1737PubMedGoogle Scholar
  33. 33.
    Tuxen DV (1994) Permissive hypercapnic ventilation. Am J Respir Crit Care Med 150: 870–875PubMedGoogle Scholar
  34. 34.
    Leatherman JW (1996) Mechanical ventilation in obstructive lung disease. Clin Chest Med 17: 577–590PubMedCrossRefGoogle Scholar
  35. 35.
    Vinegar A, Sinnett EE, Leith DE (1979) Dynamic mechanisms determine functional residual capacity in mice, Mus musculus. J Appl Physiol 46: 867–871PubMedGoogle Scholar
  36. 36.
    Kimball WR, Leith DE, Robins AG (1982) Dynamic hyperinflation and ventilator dependence in chronic obstructive pulmonary disease. Am Rev Respir Dis 126: 991–995PubMedGoogle Scholar
  37. 37.
    Pepe PE, Marini JJ (1982) Occult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction. Am Rev Respir Dis 126: 166–170PubMedGoogle Scholar
  38. 38.
    Tobin MJ, Lodato RF (1989) PEEP, auto-PEEP, and waterfalls. Chest 96: 449–451PubMedCrossRefGoogle Scholar
  39. 39.
    Ranieri VM, Grasso S, Fiore T, Giuliani R (1996) Auto-positive end-expiratory pressure and dynamic hyperinflation. Clin Chest Med 17: 379–394PubMedCrossRefGoogle Scholar
  40. 40.
    Lodato RF, Tobin MJ (1991) Estimation of auto-PEEP. Chest 99: 520–522CrossRefGoogle Scholar
  41. 41.
    Rossi A, Gottfried SB, Zocchi L, et al (1985) Measurement of static lung compliance of the total respiratory system during mechanical ventilation: the effect of intrinsic positive end-expiratory pressure. Am Rev Respir Dis 131: 672–677PubMedGoogle Scholar
  42. 42.
    Smith TC, Marini JJ (1988) Impact of PEEP on lung mechanics and work of breathing in severe airflow obstruction. J Appl Physiol 65: 1488–1499PubMedGoogle Scholar
  43. 43.
    Johnson B, Nordstrom L, Olsson SG, et al (1975) Monitoring of ventilation and lung mechanics during automatic ventilation: a new device. Bull Eur Physiopathol Respir 11: 729–743Google Scholar
  44. 44.
    Permutt S, Bromberger-Barnea B, Bane HN (1962) Alveolar pressure, pulmonary venous pressure, and the vascular waterfall. Med Thorac 19: 239–260PubMedCrossRefGoogle Scholar
  45. 45.
    Pride NB, Permutt S, Riley RL, et al (1967) Determinants of maximal expiratory flow from the lungs. J Appl Physiol 23: 646–662PubMedGoogle Scholar
  46. 46.
    Ranieri VM, Giuliani R, Cinnella G, et al (1993) Physiologic effects of positive end-expiratory pressure in COPD patients during acute ventilatory failure and controlled mechanical ventilation. Am Rev Respir Dis 147: 5–13PubMedGoogle Scholar
  47. 47.
    Ninane V, Yernault JC, Detroyer A (1993) Intrinsic PEEP in patients with chronic obstructive pulmonary disease: role of expiratory muscles. Am Rev Respir Dis 148: 1037–1042PubMedGoogle Scholar
  48. 48.
    Marini JJ (1989) Should PEEP be used in airflow obstruction? Am Rev Respir Dis 140: 1–3PubMedGoogle Scholar
  49. 49.
    Ranieri VM, Mascia L, Petruzzelli V, et al (1995) Inspiratory effort and measurement of dynamic intrinsic PEEP in COPD patients: effects of ventilator triggering systems. Intensive Care Med 21: 896–903PubMedCrossRefGoogle Scholar
  50. 50.
    Milic-Emili J, Gottfried SB, Rossi A (1987) Dynamic hyperinflation: intrinsic PEEP and its ramifications in patients with respiratory failure. In: Vincent JL (ed) Update in intensive care and emergency medicine: update 1987. Springer-Verlag, Berlin, pp 192–198Google Scholar
  51. 51.
    Tuxen DV, Lane S (1987) The effects of ventilatory pattern on hyperinflation, airway pressures, and circulation in mechanical ventilation of patients with severe airflow obstruction. Am Rev Respir Dis 136: 872–879PubMedGoogle Scholar
  52. 52.
    Ranieri VM, Eissa NT, Corbeil C, et al (1991) Effects of positive end-expiratory pressure on alveolar recruitment and gas exchange in patients with the adult respiratory distress syndrome. Am Rev Respir Dis 144: 544–545PubMedGoogle Scholar
  53. 53.
    Petrof BS, Linegare M, Goldberg P, et al (1990) Continuous positive airway pressure reduces work of breathing and dyspnea during weaning from mechanical ventilation in severe obstructive pulmonary disease. Am Rev Respir Dis 141: 281–289PubMedGoogle Scholar
  54. 54.
    Haluzska J, Chartrand DA, Grassino AE, et al (1990) Intrinsic PEEP and arterial PCO2 in stable patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 141: 1194–1197Google Scholar
  55. 55.
    Martens P, Vandekerhove Y, Mullie A (1993) Restoration of spontaneous circulation after cessation of cardiopulmonary resusitation. Lancet 341: 1217CrossRefGoogle Scholar
  56. 56.
    Kollef MH (1992) Lung hyperinflation caused by inappropriate ventilation resulting in electromechanical dissociation: a case report. Heart Lung 21: 74–77PubMedGoogle Scholar
  57. 57.
    Myles PS, Madden H, Morgan EB (1995) Intraoperative cardiac arrest after unrecognized dynamic hyperinflation. Br J Anaesth 74: 340–342PubMedCrossRefGoogle Scholar
  58. 58.
    Rogers PL, Schlichtig R, Miro A, Pinsky M (1991) Auto-PEEP during CPR. An “occult” cause of electromechanical dissociation? Chest 99: 492–493PubMedCrossRefGoogle Scholar
  59. 59.
    Lapinsky SE, Leung RS (1996) Auto-PEEP and electromechanical dissociation (letter). N Engl J Med 335: 674PubMedCrossRefGoogle Scholar
  60. 60.
    Franklin C, Samuel J, Hu T (1994) Life-threatening hypotension associated with emergency intubation and the initiation of mechanical ventilation. Am J Emerg Med 12: 425–428PubMedCrossRefGoogle Scholar
  61. 61.
    Keith RL, Pierson DJ (1996) Complications of mechanical ventilation: a bedside approach. Clin Chest Med 17: 439–151PubMedCrossRefGoogle Scholar
  62. 62.
    Pierson DJ (1994) Barotrauma and bronchopleural fistula. In: Tobin MJ (ed) Principles and Practice of Mechanical Ventilation. McGraw-Hill, New York, p 813–836Google Scholar
  63. 63.
    Pierson DJ (1994) Pneumomediastinum. In Murray JF, Nadal JA (eds) Textbook of respiratory medicine. 2nd edn Saunders, Philadelphia pp 2250–2265Google Scholar
  64. 64.
    Pingleton SK (1988) Complications of acute respiratory failure. Am Rev Respir Dis 137: 1463–1493PubMedGoogle Scholar
  65. 65.
    Braman SS, Kaemmerlen JT (1990) Intensive care of status asthmaticus. A 10-year experience. JAMA 264: 366–368PubMedCrossRefGoogle Scholar
  66. 66.
    Darioli R, Perret C (1984) Mechanically controlled hypoventilation in status asthmaticus. Am Rev Respir Dis 129: 385–387PubMedGoogle Scholar
  67. 67.
    Leatherman JW, Ravenscraft SA, Iber C, et al (1989) High peak inflation does not predict barotrauma during mechanical ventilation of status asthmaticus. Am Rev Respir Dis 139: 154AGoogle Scholar
  68. 68.
    Williams TJ, Tuxen DV, Scheinkestel CD (1992) Risk factors for morbidity in mechanically ventilated patients with acute severe asthma. Am Rev Respir Dis 146: 607–615PubMedGoogle Scholar
  69. 69.
    Slutsky AS (1993) Mechanical ventilation. ACCP Consensus Conference. Chest 104: 1833–1857PubMedCrossRefGoogle Scholar
  70. 70.
    Tobin MJ (1988) Respiratory muscles in disease. Clin Chest Med 9: 263–285PubMedGoogle Scholar
  71. 71.
    Gottfried SB (1991) The role of PEEP in the mechanically ventilated COPD patient. In: Marini JJ, Roussos C (eds) Ventilatory failure. Springer-Verlag, Berlin, pp 392–418Google Scholar
  72. 72.
    Nava S, Bruschi C, Rubini F, et al (1995) Respiratory response and inspiratory effort during pressure support ventilation in COPD patients. Intensive Care Med 21: 871–873PubMedCrossRefGoogle Scholar
  73. 73.
    Hoffman RA, Ershowsky P, Krieger BP (1989) Determination of auto-PEEP during spontaneous and controlled ventilation by monitoring changes in end-expiratory thoracic gas volume. Chest 96: 613–616PubMedCrossRefGoogle Scholar
  74. 74.
    Gay PC, Rodarte JR, Hubmayr RD (1989) The effects of positive expiratory pressure on isovolume flow and dynamic hyperinflation in patients receiving mechanical ventilation. Am Rev Respir Dis 139: 621–626PubMedGoogle Scholar
  75. 75.
    Georgopoulos D, Giannouli E, Patakas D (1993) Effects of extrinsic positive end-expiratory pressure on mechanically ventilated patients with chronic obstructive pulmonary disease and dynamic hyperinflation. Intensive Care Med 19: 197–203PubMedCrossRefGoogle Scholar
  76. 76.
    Scott LR, Benson MS, Pierson DJ (1986) Effect of inspiratory flow rate and circuit compressible volume on auto-PEEP during mechanical ventilation. Respir Care 31: 1075–1079Google Scholar
  77. 77.
    Dhand R, Tobin MJ (1996) Bronchodilator delivery with metered-dose inhalers in mechanically ventilated patients. Eur Respir J 9: 585–595PubMedCrossRefGoogle Scholar
  78. 78.
    Crogan SJ, Bishop MJ (1989) Delivery efficiency of metered-dose aerosols given via endotracheal tubes. Anesthesiology 70: 1008–1010PubMedCrossRefGoogle Scholar
  79. 79.
    Fink JB, Dhand R, Duarte AG, et al (1996) Aerosol delivery from a metered-dose inhaler during mechanical ventilation. Am J Respir Crit Care Med 154: 382–387PubMedGoogle Scholar
  80. 80.
    Diot P, Morra L, Smaldone GC (1995) Albuterol delivery in a model of mechanical ventilation: comparison of metered-dose inhaler and nebulizer efficiency. Am J Respir Crit Care Med 152: 1391–1394PubMedGoogle Scholar
  81. 81.
    O’Riordan TG, Palmer LB, Smaldone GC (1994) Aerosol deposition in mechanically ventilated patients: optimizing nebulizer delivery. Am J Respir Crit Care Med 149: 214–219PubMedGoogle Scholar
  82. 82.
    Dhand R, Jubran A, Tobin MJ (1995) Bronchodilator delivery by metered-dose inhaler in ventilator-suported patients. Am J Respir Crit Care Med 151: 1827–1833PubMedGoogle Scholar
  83. 83.
    Dhand R, Duarte AG, Jubran A, et al (1996) Dose response to bronchodilator delivered by metered-dose inhaler in ventilator-supported patients. Am Rev Respir Crit Care Med 154: 388–393Google Scholar
  84. 84.
    Hansen-Flaschen J (1997) Neuromuscular complications of critical illness. Pulm Perspectives (Am Coll Chest Phys) 14: 1–4Google Scholar
  85. 85.
    Brochard L, Rauss A, Benito S, et al (1994) Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 150: 896–903PubMedGoogle Scholar
  86. 86.
    Esteban A, Alia I, Ibanez J, et al (1994) Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. Chest 106: 1188–1193PubMedCrossRefGoogle Scholar
  87. 87.
    Lessard MR, Brochard LJ (1996) Weaning from ventilatory support. Clin Chest Med 17: 475–489PubMedCrossRefGoogle Scholar
  88. 88.
    Pierson DJ (1995) Non-respiratory aspects of weaning from mechanical ventilation. Respir Care 40: 263–270Google Scholar
  89. 89.
    Marini JJ (1995) Weaning techniques and protocols. Respir Care 40: 233–238Google Scholar
  90. 90.
    Maclntyre NR (1995) Respiratory factors in weaning from mechanical ventilatory support. Respir Care 40: 244–248Google Scholar
  91. 91.
    Pierson DJ (1995) Long-term mechanical ventilation and weaning. Respir Care 40: 289–295Google Scholar
  92. 92.
    Barrientos-Vega R, Sanchez-Soria MM, Morales-Garcia C, et al (1997) Prolonged sedation of critically ill patients with midazolam or propofol: impact on weaning and costs. Crit Care Med 25: 33–40PubMedCrossRefGoogle Scholar
  93. 93.
    Carrasco G, Molina R, Costa J, et al (1993) Propofol vs midazolam in short-, medium- and long-term sedation of critically ill patients. A cost benefit analysis. Chest 103: 557–564PubMedCrossRefGoogle Scholar
  94. 94.
    Esteban A, Frutos F, Tobin MJ, et al (1995) A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med 332: 345–350PubMedCrossRefGoogle Scholar
  95. 95.
    Pierson DJ (1995) Weaning from mechanical ventilation: Why all the confusion? Respir Care 40: 228–232Google Scholar
  96. 96.
    Ely EW, Baker AM, Dunagan DP, et al (1996) Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 335: 1864–1869PubMedCrossRefGoogle Scholar
  97. 97.
    Meduri GU, Abou-Shala N, Fox RC, et al (1991) Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure. Chest 100: 445–454PubMedCrossRefGoogle Scholar
  98. 98.
    Wysocki M, Tric L, Wolff MA, et al (1993) Noninvasive pressure support ventilation in patients with acute respiratory failure. Chest 103: 907–913PubMedCrossRefGoogle Scholar
  99. 99.
    Heffner JE (1989) Medical indications for tracheotomy. Chest 1: 186–190CrossRefGoogle Scholar
  100. 100.
    Consensus conference on artificial airways in patients receiving mechanical ventilation (1989) Chest 1: 178–180Google Scholar
  101. 101.
    Marsh HM, Gillespie DJ, Baumgartner AE (1989) Timing of tracheostomy in the critically ill patient. Chest 1: 190–193CrossRefGoogle Scholar
  102. 102.
    El-Naggar M, Sadagopa S, Levin H, et al (1976) Factors influencing choice between tracheostomy and prolonged translaryngeal intubation in acute respiratory failure: a prospective study. Anesth Analg 55: 195–201PubMedCrossRefGoogle Scholar
  103. 103.
    Muir JF, Girault C, Cardinaud JP, et al (1994) Survival and long-term follow-up of tracheostomized patients with COPD treated by home mechanical ventilation. Chest 106: 201–209PubMedCrossRefGoogle Scholar
  104. 104.
    Menzies R, Gibbons W, Goldberg P (1989) Determinants of weaning and survival among patients with COPD who require mechanical ventilation for acute respiratory failure. Chest 95: 398–405PubMedCrossRefGoogle Scholar
  105. 105.
    Weiss SM, Hudson LD (1994) Outcome from respiratory failure. Crit Care Clin 10: 197–215PubMedGoogle Scholar
  106. 106.
    Ludwigs UG, Baehrendtz S, Wanecek M, et al (1991) Mechanical ventilation in medical and neurological diseases: 11 years of experience. J Intern Med 229: 117–124PubMedCrossRefGoogle Scholar
  107. 107.
    Seneff MG, Wagner DP, Wagner RP, et al (1995) Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbations of chronic obstructive pulmonary disease. JAMA 274: 1852–1857PubMedCrossRefGoogle Scholar
  108. 108.
    Gottlieb LS, Balchum OJ (1973) Course of chronic obstructive pulmonary disease following first onset of respiratory failure. Chest 63: 5–8PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 1998

Authors and Affiliations

  1. 1.Department of Critical Care MedicineNIHBethesdaUSA
  2. 2.Division of Pulmonary and Critical Care MedicineHarborview Medical CenterSeattleUSA

Personalised recommendations