pulmonary disorders
Treatment of Acute COPD Exacerbation
Ventilatory Assistance in Acute COPD Exacerbation
 Noninvasive positive pressure ventilation (NIPPV) (eg, pressure support or positive airway pressure ventilation by face mask) is an alternative to full mechanical ventilation. Noninvasive ventilation appears to decrease the need for intubation, reduce hospital stay, and reduce mortality in patients with severe exacerbations (defined as a pH Noninvasive ventilation appears to have no effect in patients with less severe exacerbation. However, it may be indicated for patients with less severe exacerbations whose arterial blood gases (ABGs) worsen despite initial drug or oxygen therapy or who appear to be imminent candidates for full mechanical ventilation but who do not require intubation for control of the airway or sedation for agitation. Patients who have severe dyspnea, hyperinflation, and use of accessory muscles of respiration may also gain relief from positive airway pressure. Deterioration while receiving noninvasive ventilation necessitates invasive Overview of Mechanical Ventilation . Deteriorating ABG values, deteriorating mental status, and progressive respiratory fatigue are indications for endotracheal intubation and Overview of Mechanical Ventilation . Ventilator settings, management strategies, and complications are discussed High-flow nasal oxygen therapy has also been used for patients with acute respiratory failure due to a COPD exacerbation and can be tried for those who do not tolerate noninvasive mask ventilation. 2 weeks), a tracheostomy is indicated to facilitate comfort, communication, and eating. With a good multidisciplinary Pulmonary Rehabilitation , including nutritional and psychologic support, many patients who require prolonged mechanical ventilation can be successfully removed from a ventilator and can return to their former level of function. Specialized programs are available for patients who remain ventilator-dependent after acute respiratory failure. Some patients can remain off the ventilator during the day. For patients with adequate home support, training of family members can permit some patients to be sent home with ventilators. Overconcern about possible ventilator dependence should not delay management of acute respiratory failure; many patients who require mechanical ventilation can return to their pre-exacerbation level of health. 