Mechanical Ventilation in Obstructive Lung Disease

Abstract

Acute respiratory failure (ARF) is defined as failure of respiratory activity to provide homeostasis to maintain oxygen uptake and carbon dioxide clearance. This can lead to end-organ dysfunction, coma, and death. Two forms of acute respiratory failure have been defined: hypoxic and hypercarbic respiratory failure. Patients who develop acute hypercarbic respiratory failure show the inability to generate adequate minute ventilation (V_E) by either reduced drive to breathe or ineffective V_E from increased work of breathing. Patients with obstructive lung disease tend to fall into the latter category.

Understanding how to appropriately manage the ventilator in patients with obstructive lung disease requires a foundational understanding of the pathophysiology of the disease process itself. At first glance, the ventilatory strategies needed to manage obstructive lung disease is counter-intuitive. However, with understanding of pathophysiology, it would make sense why particular interventions are performed to clinically improve patient as well as prevent iatrogenesis. In this chapter, we explore in details the management of ventilated patients with obstructive lung disease focused on the nuances of the ventilator tailored to each pathophysiology.